The type of lesion described is certainly consistent with yeast, and the
type of injury as well.  I would also try culturing for bacterial growth
from the lesions themselves and if positive for S. aureus, consider systemic
antibiotics.  A nipple vacation and manual expression, not pumping, would be
my choice if it is not possible to achieve painless feeding with corrected
latch.  If I have understood correctly she has the kind of fissures that get
pulled apart by a pump but are virtually unaffected by manual expression.

What really jumped out at me was this, from the mother's account:
"I have tried to force him too stay on by holding his head, but that just
makes it worse. He screams and cries."

Good she realizes that it makes it worse to push his head, that is actually
quite observant of her.  This baby needs time, and both of them would
definitely benefit from skin-to-skin at other times than feeding, as often
as physically possible.  I would strongly recommend co-bathing to increase
the effects of skin-to-skin.  If this little guy is allowed to crawl around
on mother's body at his own pace while she lies on her back, uncovered, I
bet anything she will experience that affirmation from him that he really
DOES want to be there, and she needs this.  His oral cavity has been
invaded, he was separated from her, and now they both need time to find each
other.  Baby should not be desperately hungry when this is attempted, and
can be fed by cup, syringe, whatever, to take the 'edge' off.

There may be other treatments for the baby, such as cranio-sacral therapy,
to un-tense his jaw, but that may not be available where they live.  They
both have skin and I bet they have a comfortable place to lie down too.  If
there is a bathtub, so much the better, but you can do wonders with only a
bed, and tincture of time.

Nine years ago I worked with a dyad in which baby had multiple medical
problems not related to breastfeeding, AND they got thrush, and she gave her
nipples a rest for a couple of weeks, which was what it took.  (He had
several similar features to what Mari describes, of screaming, and arching
away, while holding the breast clamped in his mouth, yowie!)  Three other
BFing mothers in their circle of acquaintances let him nurse during that
time so he had at least one breastfeed every day and the rest, all expressed
milk from his mother, was given by cup or bottle, I can't remember now.  He
was painfully grateful for those surrogate breasts.  I was not so
knowledgeable then, so we didn't take precautions and at least one of the
other mothers developed thrush, but hers resolved quickly and didn't affect
her own baby.  The baby who was wetnursed was weaned from his mother's
breast at age 5, so I think it is safe to say we all saved that BF
relationship!

Keep us posted on their progress, OK?
Rachel Myr
Kristiansand, Norway

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