Hi Laurie, I've used an inverted syringe in my practice to pull out nipples, and it works beautifully. I teach the mom how to do it, and she uses enough pressure to pull out the nipple, but reduces the pressure if it hurts. Since the diameter of the syringe is so small (and I use either a 12 cc or a 20 depending on the size of the nipple), it is far more effective at pulling out the nipple than the pump. There will be comments from some that it isn't FDA approved for nipple sucking. Guess I will personally take my chances and do what works, rather than wait for the wheels of the FDA to grind ever so slowly. The nipplette has been out several years, but not yet approved by the FDA for use in the US, so you can only get it in the UK, Israel, Canada.... If you are concerned about legalities, if it isn't approved for use in the US, you can't use it in the US. There was an excellent article in the JHL, March, I think, of 91? 92? re the use of the inverted syringe. Jan B.