In general, " nuk" shaped nipples are caused by baby closing the jaw on the
underside of the nipple shaft rather than closing over the breast.  Distortion
of the shape of the nipple is generally an indicator of poor latch. We often
miss this because we look at the upper jaw and nose instead of checking the
position of the chin.

 There are pictures of good and poor latch in The Breastfeeding Atlas, along
with a detailed explanation of  what causes it.  Renfrew and Fisher's book,
Bestfeeding, and Felicity Savage-King's book, Helping Mothers to Breastfeed,
also show babies correctly and incorrectly positioned at breast.  Because babies
have receding lower jaws, their noses line up only with the top (stationary)
jaw.  The lower, moveable,  recessed jaw, must be tilted toward the breast to
prevent it from closing on and crimping the nipple shaft.  You have to pick
(with most babies) whether to have the nose or the chin touch the breast.  Chose
the chin.  This will tip the nose back, which has the added advantage of opening
the nostrils for breathing, and puts the baby's eyes in a gaze line with
mother's eyes.  If, on the other hand,  the nose is pressed into the breast, mom
has to go to the trouble of pushing away breast tissue, can't see baby's eyes,
and baby has to try to "bite the big apple" with it's chin is jammed into its
neck (making it harder to breathe and swallow).

To get the baby to go to breast with slight extension of the head, tickle the
UPPER lip with the nipple and the baby will root up.  This forces baby to open
wide and reach for it. Chin will thus  be planted on the breast first, and
should be a bit backed off from the nipple.  When latched on properly, there
should be more areolar target showing above the baby's upper lip, but the chin
side should be covered.  So it's an off-center target, with a chin in, nose out
approach.  Cheeks should be right up against the breast, and mother supports
baby at base of neck and shoulders, not with pressure on head (which as you will
see by placing your own hand on head and pushing will flex your neck and put you
back in a nose-dive).

Nipples should not look distorted after feeding.

It can be difficult to understand latch technique because of the variability of
teaching vocabulary and because the cartoon schematic drawings to teach this
(even in some respectable books) are so often  awful.  They frequently show
impossible diagrams (from a physiologic standpoint).  I recommend Diane
Wiessinger's wonderful JHL article on the subject, and Chloe Fisher's videos.

While clenching and sucking problems can have causes such as stressful birth and
neurological issues, the far more common cause is simple incorrect latch.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
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http://www.jump.net/~bwc/lactnews.html

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