Anne, it is very very important that a baby with a recessed chin be 
latched on properly as the chin must be smooshed into the breast and the 
nose tipped out. I love the nipple to nose technique and I find that 
babies will open wider using that technique and getting an nice 
asymetrical latch gets that chin in the right place. What this means is 
that you position baby right up to mom's nipple on the baby's top lip or 
above it. The chin and face are up close on the breast or touching the 
breast. The nipple on the top lip tells baby to open wide, they tip 
their heads back and come on with a wide gape. Baby may need her head 
tipped just a tiny bit back like when you drink a bottle of water. This 
positions the chin into the breast tissue and the nose is tipped out. 
Make sure the mouth is wide open on the breast like a yawn. If the 
corners of the lips are meeting or tight, baby is on the nipple only and 
not taking in enough areola. Many babies try to tip suck on a longer 
nipple if latched incorrectly. Also, more areola tissue should be near 
the bottom lip and less tissue under the top lip to position the chin 
right. It is more helpful to position mom's hand to support baby's neck 
and shoulders instead of supported by the crook of the arm or forearm. 
Football hold or clutch hold works well. And sometimes a 24 mm Medela 
Nipple Shield is big enough to sort of smoosh mom's nipple into it to 
make it smaller until baby grows. But I have had such good luck with 
latching better with the nipple on the top lip and waiting for baby to 
open wide that I rarely need to use anything else. The "nipple sandwich" 
technique where mom compresses her areola just above where baby should 
put her lips may work also to get more into baby's mouth (combined with 
an asymetrical latch). Good luck to this mom, Kathy Eng, BSW, IBCLC

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