Paula,
Earlier this year I consulted with a mom and baby who were not a good fit.
Baby simply could not take enough breast tissue into her mouth to do an
adequate job and avoid injuring her mother.  Mother was a very average size.
Baby, however, had a smallish oral cavity and lip opening was unusually
small.  I advised mother  to pump with a hospital grade, double pump to
build and maintain her supply, do lots of skin to skin daily, and feed with
a Gerber nipple, symetrical shape, 0-3 months, slow flow.  With baby's lips
fully stretched and flanged almost touching the cap and the nipple filling
most of the oral cavity she fed well for 3 weeks until she had grown
sufficiently to nurse directly at breast fulltime.  This was mother's second
baby. The first had no problems. She was fearful of baby not transferring
back to breast so she attempted nursing once or twice daily during this
time - as much as her damaged nipples could permit.

With a recessed chin, baby needs to be led to breast chin first. Mom presses
baby's shoulders and neck toward her at latch on, using a crosscradle or
football hold.  It may help to pump the breast briefly, to soften the areola
first, so baby can get a deeper latch with his chin deeply embedded into the
softened breast.

Hope this helps,

Anne Grider, IBCLC

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