Hello, Cheryl.
       You wrote about an 18-mo-old who has been ill and is now sucking
improperly and tearing up his mother's nipples.  You wondered if my method of
bottle-feeding would help him re-learn the proper technique.  I have to be honest
and say I don't know of anyone trying to get such an "older" child to accept a
bottle.  Most moms would be leary of doing so for fear they would then have
trouble weaning from the bottle.  And most toddlers who are still breastfeeding
are getting sucking needs met at breast, so don't need a bottle.
       If the mother you are working with decides to give bottle-feeding a
try, I would still recommend the small-mouth bottle and a nipple with a base
about 1 inch across--*not* the Avent nipple.  Although this toddler *might* (and
I'll explain why I think he might *not* in a bit) be able to get his mouth
around the base of the Avent nipple, this nipple does not have a natural curve
(taper) from base to nipple, so it certainly wouldn't teach him how to place his
tongue properly against mom's breast.  Also, mom's milk sinus has not moved
as her baby grew older.  If you look at pictures of older babies and toddlers
at breast, you will notice that their mouths are *not* as wide as they can
possibly be, because that would put their gums behind mom's milk sinus.  It might
even cause them to gag, since they would be drawing a lot more breast tissue
into the mouth and it would naturally be drawing farther back into the mouth,
if these babies with larger mouths opened as wide as they could.  So, based on
mother's anatomy, the small-mouth bottle would still probably be the
appropriate bottle to use.  And if mom tries this, I would strongly suggest she let the
bottle nipple soak in expressed breastmilk for 24 hours before attempting to
get toddler to take the bottle, so the nipple tastes a little more like what
he's used to.
       Here's why I'm wondering if this little guy would even be able to get
his mouth around that wide Avent nipple base:  You talk about how he has
pursed lips and tight jaws, even when mom makes him let go and re-attach.  You also
mentioned that he has had back-to-back colds and has had an earache.  (I
wasn't clear from your post if the earache came during the time of the colds, or
prior to that.)  Many times, the thick mucous of colds gets stuck in the
eustachian tubes, and babies get ear infections secondarily to the colds.
Breastmilk fights infections without inflammation.  Breastfed babies can have ear
infections without red eardrums, because of the lack of inflammation.  But that
doesn't mean there isn't extra fluid behind the eardrum.  And that extra fluid
can cause pain whenever baby tries to open his mouth, because the TMJ
(temporomandibular joint) is directly in front of the ear and motion in that joint can
cause motion and resulting discomfort in the structures of the ear.  Sometimes
CranioSacral therapy or pediatric chiropractic can help that excess fluid
drain and relieve the pressure.  And sometimes, even though not all ear infections
need or respond to antibiotics, sometimes I have seen antibiotics help
relieve the pain that was keeping a baby from moving his jaw well.
       I do think that your suggestion to stop using the sippy cups is a good
one.  This baby seems to be confused about what to do, and handling more than
one style of sucking right now may be just more than he can handle.  Even if
his problem is pain rather than confusion, he might *become* confused as he
begins to feel better and he hasn't been able to breastfeed with proper
technique in the recent past, because the suck he was most recently able to perform
with results was the one he used on his sippy cup.  So, for now, mom may indeed
need to get that sippy cup out of the picture as baby tries to re-learn the
correct attachment and suck as he is able to move his jaw farther.  Consistency
may be the key to helping him "remember" the right way to breastfeed.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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