Hello all,
Mom has given permission for me to post, as we are stumped. She is 2nd time mom to an 11 day-old, seen by me on Wednesday last (infant was 8 days at the time of our visit). She has bilateral nipple cracks on the upper tips. Infant was observed to have shallow latch and difficulty maintaining a good seal. 
Infant tested for suck, very tight mouth and jaw, he chomps down and does not tolerate any stimulus on either his palate or mid-tongue (response = gagging). Mother has experienced unrelieved engorgement since day 3 postpartum, when her milk "came in".  Mom had been pumping to relieve fullness, with any more than a two-hour interval causing her great discomfort. She breastfed infant every 2 - 3 hours, or when he showed interest cues.   Infant gaining well, and stooling yellow. As mom reported that latch was less painful when her breasts were softer, we practiced some position changes and discussed ways to get infant to open wider, but she chose to primarily focus on taming her oversupply.  Full draining and block feeding method was described at our visit, mom skeptical but willing to try anything.  Mom tried  full draining pump attempt on Wednesday after our visit. She reported pumping for 45 minutes without any sign of milk flow slowing. She attemped to block feed and still felt the need to express for comfort the rest of Wednesday.  On Thursday Mom followed up with her physician on recommendation for evaluation for pain medication and guidance. Mom has been prescribed antibiotics for bi-lateral mastitis and dr. prescribed nystatin ointment for her nipple wounds. (mom's breasts were full but no signs of blocked ducts or mastitis symptoms noted on Wed., at Thurs visit mom reported phys detected a large lump deep in her breast.)  Of interest is mom is taking Wellbutrin. Mom also going to try peppermint to lower supply. 
If I've missed anything, I'd be most grateful for your instruction and guidance. This mom and I would be be appreciative of any suggestions to help her situation.  Sorry for the long post.
Kindly,
Leslie Cree, IBCLC

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