In dealing with large nipples (and I've got two going right now), I first
start with lots of breast shaping and different angles of "attach".  My moms
with large nipples have rarely had perfectly symmetrical ones, and so one
position may reduce the nipple diameter by as much as 1/4 inch, which can
make a difference.  I am also very proactive-- I don't let mom and baby take
a passive approach to latch, where baby directs, but rather I have mom tickle
baby's lower lip to elicit a wide gape, and then I have her RAM the baby on.
RAM=Rapid Arm Movement, and is not violent, is not "shoving", but rather very
assertive. This maximizes what baby can really take in.

If baby is not feeding well or at all despite all of these measures, then I
favor fingerfeeding, or should I say instead, thumbfeeding. It is often very
helpful for mom and dad to choose a finger that is closer to the diameter of
mom's nipple to help baby adapt going back to breast faster.  This can be
done by p-syringe, medicine dropper or SNS.  The most important thing to
remember is that large nipple/small mouth is a temporary syndrome. If we get
baby fed and growing, he/she *will* eventually grow into that nipple and be
able to accomodate it; the name of the game is patience and waiting. For this
reason, I don't like to mess around at the expense of growth, as growth is
such an important factor. Feed the baby and work the mechanics out, in that
order or simultaneously.

-Lisa Marasco, LLLL, IBCLC
Santa Maria, CA