Let's first define the term "large nipple," keeping in mind that pregnancy and lactation can cause nipples to enlarge. In fact, during the first few weeks postpartum, with engorgement at an all-time-high, once "average"-sized nipples may seem large, yet return to their normal state as the engorgement subsides.
So, what is a truly "large" nipple? Here is how they're categorized (all measurements are at the base of the nipple:
- Small: <12mm
- Average: 12 to 15mm (about the size of a dime)
- Large: 16 to 23mm
- Extra-Large: >23mm
Critical to breastfeeding success is having mom, baby, and nipple in sync. Many babies do not have any problems breastfeeding with a mom who has large nipples. However, if the baby is small or weak (and has a small mouth), it may be troublesome for him to get his mouth deeply onto the breast, and that may make it hard from him to get milk. Remember that the milk ejection reflex only occurs when the baby is fully compressing the breast's milk ducts, which requires getting his mouth as far back as possible beyond the nipple. In cases like this, we have to monitor his weight gain, and how many diapers he is wetting (at least 6 to 8 per day) and/or soiling (at least 4 to 6 per day). These markers are critical. Being mindful of the above is the key to knowing whether or not the baby is obtaining enough milk at the breast.
As always, if you have any questions or concerns, seek the help of a lactation consultant.