When a newborn is ready to feed, the shape of the breast and nipple must be conducive to establishing an effective latch. Many parents find that their nipples are naturally flat or inverted, which can create an initial obstacle to successful breastfeeding. Achieving temporary nipple firmness and protrusion is often necessary to provide the infant with a clear target and sufficient tissue to grasp deeply. Focusing on simple preparation techniques to encourage the nipple to stand out can make a significant difference in the first attempts at feeding.
The Role of Nipple Firmness in Latching
A successful breastfeeding latch requires the infant to take a large mouthful of breast tissue, not just the nipple tip. A firm, protruding nipple serves two primary functions: it acts as a target for the baby and stimulates the infant’s palate. When a nipple is flat (level with the areola) or inverted (pulling inward upon stimulation), the baby may struggle to grasp enough tissue to create the necessary seal.
The protrusion of the nipple helps guide the infant to draw the areola deep into the mouth. This places the nipple near the junction of the hard and soft palate, triggering the baby’s sucking reflex essential for effective milk transfer. While the baby primarily breastfeeds on the areola tissue, the initial firmness and length of the nipple help the baby maintain the deep latch without the tissue slipping out.
Flat nipples may lengthen and protrude once the baby begins to suck and create suction. However, inverted nipples, which are often tethered by shortened milk ducts or connective tissue, may not respond as easily. Using techniques to temporarily draw out the nipple helps overcome these anatomical challenges, providing the infant with the best possible starting point for a deep and comfortable latch. Preparing the nipple just before feeding is key.
Immediate Physical Techniques for Firmness
Simple, hands-on methods can be performed immediately before a feed to encourage the nipple to protrude and become firmer.
One technique involves the “nipple roll,” where the nipple is gently rolled between the thumb and forefinger for about 30 to 60 seconds. This manual stimulation triggers the natural erection reflex, causing the smooth muscles around the nipple to contract and temporarily increase protrusion.
Applying a brief exposure to cold can also cause the nipple to become firmer and stand out more prominently. This can be accomplished by briefly touching the nipple with a cold, damp cloth, a chilled spoon, or an ice cube wrapped in fabric. The cold should only be applied for a few seconds to avoid discomfort, but it is often enough to provoke a temporary physical response.
Gentle pressure applied at the base of the nipple can help push the tissue forward for the baby to grasp. This is incorporated into the “Hoffman technique,” which involves placing the thumbs on opposite sides of the areola. Gently stretch the skin outward while pressing slightly inward toward the chest wall. Repeating this motion in a few different directions can help break up minor adhesions that contribute to flatness.
Mechanical Aids and Pre-Feed Preparation
If nipples do not respond sufficiently to manual manipulation, temporary use of mechanical aids can help draw the tissue out just before a feeding session.
Suction Devices
Using a breast pump for a minute or two on a very low suction setting creates a gentle vacuum that pulls the nipple forward. This brief pumping session encourages protrusion and can also initiate milk flow, which further entices the baby to latch.
Specialized devices known as nipple everters are designed to create gentle suction. These tools are placed over the nipple and manually squeezed or pumped to gently draw the nipple out for 30 to 60 seconds. Alternatively, the reversed syringe technique uses the barrel and plunger of a clean, small syringe to create a similar, controlled vacuum without the need for specialized equipment.
Nipple Shapers
Another mechanical aid is a pair of breast shells or nipple shapers, which are firm plastic discs worn inside the bra. These devices apply continuous, mild pressure around the areola over time to encourage the nipple to protrude gradually between feeds. When using any suction device, keep the duration short to prevent discomfort or tissue irritation. The brief use of these tools provides the necessary target for the infant to establish a deep, effective latch.
Addressing Persistent Latching Difficulties
If preparatory techniques, both manual and mechanical, do not consistently result in a successful latch, a temporary tool called a nipple shield may be used. A nipple shield is a thin, flexible piece of silicone worn over the nipple and areola, providing a firmer, more consistent target for the baby to grasp. This can be especially helpful while the baby is learning to coordinate the suck-swallow-breathe pattern.
The use of a nipple shield should always be considered a short-term measure, and professional guidance from a certified lactation consultant (IBCLC) is highly recommended. An IBCLC can assess the precise reason for the latching difficulty, which may not be solely related to nipple shape.
Other factors, such as infant positioning, engorgement, or an anatomical issue like a tongue tie, can interfere with a good latch. A professional assessment ensures the shield is the correct size and confirms the baby is effectively transferring milk and gaining weight. An IBCLC can also help develop a plan to transition the baby back to the bare breast once initial challenges are overcome. Continued support is important for establishing a comfortable, long-term breastfeeding relationship.