Isabella
Thanks for the good description. The red flags for me in this would be
1) static weight from 4 - 14 days (suggest increase frequency of BF
episodes, and perhaps use breast compression/switch-nursing to
increase intake, or have mom feed some of that EBM that she pumps
after feeding - not sure why she's doing this??)
2) nipple distortion and pain, pinched nipples and L nipple
elevations when baby comes off. Sounds like the baby is placed too
high on the nipple/areola, ie baby doesn't have enough of the
underside of the areola in the mouth. This can result in a
lipstick-shaped nipple, which can be seen briefly when the baby
unlatches. I'd suggest thoroughly reviewing latching techniques with
this mom, and using the technique whereby thumb is placed above the
areola to depress the tissue on latching, so that the nipple tips up,
and more of the underneath of the areola is planted on the baby's
tongue as she gapes to latch. As soon as the baby is latched, mom
should let go the thumb to relax the breast tissue, allowing the
nipple tip to go further into the baby's mouth, but she should keep
supporting/cupping the whole breast from underneath throughout the
feed so that the breast is effectively being "poured" into the baby's
mouth. This takes the weight of the breast off the baby's lower jaw,
and allows more of the nipple/areola tissue to remain inside the
baby's mouth during nursing, rather than gravity pulling it back out
again. It can help sore nipples to vary the positioning too - if
she can only nurse in the football, can you perhaps show her how to
nurse in cross-cradle (lots of pillows to support baby, mom's arms
etc) so that the area of friction on the nipple is varied?
Hope these ideas help. These are what I would try before rushing to
conclude that the problem is "only" TT, and that a quick snip will
fix everything!
Pamela Morrison IBCLC
Rustington, England
-----------------------------------------
Date: Mon, 28 Jan 2013 16:59:59 -0500
From: Isabella Mendoza <[log in to unmask]>
Subject: May be missing something / distorted nipples
Please let me run the basics past you-all and see what I might be
missing. Permission to Post: Mother is bfdg her 2week old girl,
second time breastfeeding. Hospital birth, but completely natural
with no meds. Baby weighed 7/15 at birth, and 8/2, 4 days later. She
was complaining about nipple pain from the very beginning, her
nipples both looked a bit pinched. [She has a brother with a minor
tongue tie, which was never fixed. She breastfed him for 11 mo]. The
2wk old does have enough soiled and wet diapers. The Pedi says the
bili is still a ittle high (13 I think) and wants mom to bring baby
for weight checks frequently because the weight gain has leveled off.
It was still 8/2 on Friday, which was at 2 wks.
She states one side (L) especially is distorted in a strange way:
where the edges of the nipple core are sort of elevated when baby
comes off. I have seen this before, but I don't remember
understanding the cause. She says pain is a "little" better than it
was two weeks ago but it still hurts. She saw the Pedi dentist with
this baby at about 1 wk and dentist said no TT. Pedi Dentist said
problem is "strong suction".
I checked positioning, baby's "wide open gape", stool & urine count
(good), milk is easy to express by hand. Mom is able to feed for
about 30 minutes in football only and she can still pump +- 2 oz
after the feeding. (She wants to do that, not my idea).
What am I missing??? Help!
Isabella
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