Hello to all,

I would appreciate any help with a stubborn case of cracked nipples.  Mom of
2nd baby didn't have problems with first babe.    Nipples became sore and
cracked almost immediately.  Baby's weight gain is adequate.  Feeding
schedule irregular but often.  Pain is only in nipples which have a reddish
appearance but not obvious yeasty look.  There is no thrush that can be seen
in baby's mouth.  Pediatrician insists there is no yeast and baby does not
need to be treated.

I first saw this mom when the baby was two weeks and two days.  Both nipples
had deep. wide fissures.  Mom was pumping one side and only feeding baby on
the other.  The side that got a break felt better immediately, but each time
she resumed breastfeeding it got worse again.

Mom had tried shells and shields. She didn't like shields and felt the baby
couldn't get a good latch.  We discussed milk supply too as she felt it was a
bit low.  Baby has high palate but does not gag on a finger and sucks well.
 Mom and Dad seemed eager to learn finger feeding with periodontal syringes
to give the pumped milk from the side she wasn't feeding on, but two weeks
later admits she has not used the syringes.

Mom has tried lanolin, antibiotic cream and a special formulation cream which
her midwife had a pharmacist make-up after talking with me.  This special
ointment has nystatin and triamcinolone.  She does not think it is working,
although today the cracks looked smaller on the side she hasn't been feeding
on.  That side bleeds when the baby breastfeeds and she has been spitting up
blood.

This mom is very motivated and has a supportive partner.  Her sister came
with her to the second appointment and was also supportive.  Mom was in tears
today feeling hopeless.  We have worked on getting baby to open wider and get
a good latch and this mom seems as relaxed as anyone could under the
circumstances.  Her milk ejection reflex works great, despite the pain, and
milk flows and drips easily.  Her left nipple is much bigger than the right
one and baby seems to feed better on the smaller one.  We again discussed
trying shields and I showed her how to get them on. She is considering taking
baby off the breast altogether and syringe feeding her for a couple of days
to see if that promotes healing.  Mom is healthy, no allergies or
medications.

Any and all ideas will be appreciated.  Baby is now 4 weeks old and the
cracks are still formidable.  Why won't they heal?  Could there be an
underlying infection that the ointments aren't getting to?
TIA for your suggestions,

Janaki Costello, IBCLC, CCE, CD. LLLL