> The yeast is much better, but the baby has taken up biting.  The baby
>approaches the breast with the tongue back, and in addition, bites on and off
>as he sucks.  The latch seems deep enough, but the tongue doesn't seem to stay
>grooved and in place all of the time.

Marilyn -

I'm going to propose another possibility altogether:  that this woman has a
breast infection as a result of earlier or ongoing nipple trauma and would
benefit from a systemic antibiotic.

It's mighty hard - for me, at least - to distiguish reliably between thrush
and certain bacterial infections that masquerade as thrush.  It *seems* to
me that one difference is that the woman with a bacterial infection may
complain of a "bruised feeling" under her areola, as if the baby's gums are
clamping or as if she has an invisible bruise.  It's not the baby, it's the
mother's inflamed tissue.  I've seen a couple women who were treated for
weeks with Diflucan and whose breast pain finally resolved with antibiotics.

Verity Livingstone's article in JHL (Livingstone V, Stringer JL.  The
treatment of Staphylococcus aureus infected sore nipples: a randomized
comparative study.  JHL 1999; 15(3): 241-6) was a real eye-opener for me.
I'm not sure it happens often, but I've seen it happen.  Here's her
description of a couple of my clients:  "Five study mothers complained of
severe sore nipples with deep, radiating, burning breast pain and episodic
vasospasms of their nipples unrelated to immediate suckling."

Good luck!
--
Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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