Nipples too big for baby's mouth?

JJ1973 · January 2014

I am a veteran breastfeeding mom (successfully breastfed my oldest for 18 months). However, I have been having difficulties successfully feeding my newborn, who was born by c-section at 37 weeks following a complication (two weeks ago this Thursday). Things got off to a rough start because of his NICU stay (concerns re: his breathing that resolved after 5 days). Despite that, I was able to initiate breastfeeding while he was in the NICU - no supply concerns and no supplements. We just had some latching issues that seemed to be due to the size of my nipples, his early term status (sleepy, etc.), and his small mouth. Since we've come home, the latch issue has escalated. He is now more hungry and becomes quickly frustrated with latching. We had our first two pediatrician appointments and within 3 days, he only maintained his weight (didn't gain), so the pediatrician recommended supplementing with formula or expressed milk. I am now nursing about 10 times a day (best I can) then pumping afterwards and giving my LO about 1- 1/2 ounces of expressed milk (whatever I can squeeze out). I have several concerns about this routine. I did not anticipate introducing a bottle this early and I worry it may decrease his interest in taking milk from my breasts (the harder way). I did have a lactation consultant come visit and she gave some helpful hints re: positioning and the use of a nipple guard (which I really hate, but it sometimes works to decrease frustration).

I guess my questions are as follows:

1. Is there anyone else out there who has had a mismatch re: size of nipples and mouth of the infant? If so, how did you handle this (any tricks)?

2. How long did it take to resolve and were you able to preserve the exclusive breastfeeding relationship? The pediatrician seems to think that the baby will more likely take my breasts when his mouth grows larger. But I'm worried about my sanity right now in this interim period given the schedule we are on and the frustration I see in him at every feeding. This is definitely different than my first born and is so discouraging.

3. We have a weight check today and my guess is that if my LO did not gain any further weight, formula supplementation will be revisited. I'd rather not go down this road (seems like a slippery slope) but I will do whatever is best for my LO, obviously. Is there anyone out there who supplemented with formula in the early weeks and was able to fade this back to exclusive breastfeeding? Just curious.

Thanks in advance for any input.

Asivec · January 2014

Why formula? Could you use a syringe/feeding tube set up and pumping to feed? You attach the feeding tube to the end of your finger and feed that way. I know it's a pita, but it would preserve the bfing relationship.

You could try a nipple shield to give a solid thing to latch on to. It may or may not work.

Here's some information on alternative feeding.
https://kellymom.com/bf/pumpingmoms/feeding-tools/alternative-feeding/#FF

agfox92 · January 2014

I think I had a similar problem, just slightly different. I have/had awkward inverted nipples and so I had to use a breast shield for nursing until LO got a good latch down. I think it was hard to latch because they were small. But once she got the latch down with the shield, we were able to transition back to just the breast. By that time my supply was helping form more of a nipple. So now she latches great. Plus due to the complications, she was supplemented with formula 3-4 time until we got it down and I could pump some BM which we syringe fed her. This all happened the first week or two. By her two week check up we had stopped using the breast shield and she was latching. Stick with it!

VitaLuna · January 2014

My LO was also born at 37w for oligo/IUGR. We had major latch issues in the beginning. We did finger feeding in the beginning (colostrum in the syringe, then put pinky in the mouth and push the colostrum in as she sucked). I ended up having to use a shield until she was ~3 wks old. I HATED it and was very emotional about it (worrying that she'd never BF "normally", etc), but it was what she needed to eat, so that's what we did and she gained fine.

ETA: by about 6wks, she was nursing like a champ and you never would've known she had a rough start.

platypusbaby · January 2014

I had similar experience as pp. pre-term baby that couldn't latch right away. I would attempt to have her latch with the nipple shield and then pump while my husband fed her the bottle. Slowly she was able to take more and more from the breast and needed less from the bottle. By 3 weeks we were no longer supplementing with the bottle and by 6 weeks we didn't need the shield anymore. I know it is extremely emotional and nerve wracking, but you will get through it!!

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