I just saw a wonderful presentation at our WIC by Barbara Wilson Clay on latching on. If the nipple is coming out pinched, then the latch on is not right. It might look ok from the outside but Barbara said the nipple is not far enough back in the mouth. I would suggest the asymetrical latch where the nipple is put on baby's nose or under the nose and let him open wide and come up for the nipple. So more of the jaw is smooshed into the breast. You could also have a jaw clencher but these babies usually have the tight lips and the fish lip or pucker up kiss type of lips. Not a wide open U at the corner of the lips. Baby might have a tongue tie in the posterior end that is easily missed except for mom's pain. If he does not have enough tissue into his mouth, he will get reduced milk flow because the jaws pinch in the wrong spot. The jaw needs to be smooshed into the breast because it does the work and if it is hanging out away from the breast, the baby is going to clamp down or use its gums to milk the breast and hang on. If the weight gain was better I would suggest maybe a too fast MER because of the pinching and the unhappiness at the breast (with the good weight gain). These babies are often unhappy at the breast and stay on forever because they are looking for comfort sucking and are fussy after nursing. I have seen many like this slide down to the tip of the nipple and "bite" to stop the too fast flow. LLLI says normal weight gain is 170 grams or 6 ounces per week and if this baby gained only 220 in the last two weeks that sounds low to me. If mom is in severe pain and you are using the asymetrical latch with the chin smooshed into the breast, she may need to pump every other feeding and use a wide based bottle, slow flow nipple for those feedings. Make sure she has large enough flanges or this could be pinching her nipple and contributing to the problem. If baby can not open wide enough on something like an Avent, or wants to tip suck with a tight mouth on the Avent (lips below the wide base or just up to the wide base), this leads to a jaw clencher where CST helps. Some babies clench so tight there is a white ring around the outside of their lips on the breast and bottle. You can see the tension in the muscles of the face. When I am not sure what is going on, and test weights show poor intake but mom can pump more than baby's intake at breast, I watch the baby bottle feed (if already getting bottles) because I can see how the lips grip the bottle nipple and it tells me a lot (either too tight with too much tension, or too loose where one lip is not gripping at all). Can mom pump more than test weights show for intake? If yes, the leads to an oral motor problem or tongue tie. She's a trooper for continuing so long! Hope this helps, Kathy Eng, BSW, IBCLC, Houston, TX *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET email list is powered by LISTSERV (R). There is only one LISTSERV. To learn more, visit: http://www.lsoft.com/LISTSERV-powered.html