Jane
If the latch has been poor for first weeks, this can lead to supply
problems. Make sure supply is adequate and baby is gaining well. (sounds
like ok output). Did you see in the archives about Jack Newmans all purpose
nipple ointment (apno)?  This is an antibiotic/antifungal/cortisone combi
ointment. Sometimes we have to use the antifungal/cortisone with an
antibacterial. Also some of the hydrogel dressings may help. Check archives
on this too.

Check for tongue tie. Can baby extend tongue? If not this, Maybe try finger
fdg for short time before latching. Latch when the suck feels normal, ie.
the baby is cupping his tongue around and extending it to the first knuckle
on your finger and moving in the peristaltic wave. Sometimes you have to
eval. this w/ fluid. Sometimes bottle feeding with a slow-flow, soft
silicone, wide based nipple can help retrain the suck. This is in archives
too somewhere. If baby is not latching well and draining breasts, mom may
need to express/pump after feeds. Some moms feed one side per feeding and
then pump the other. If baby needs more milk after one side, give per
alternate method.

I hope this next section is not too basic. I always recommend getting baby
and mom naked from waist up whenever we are having this degree of soreness.
The stripe tells you something is really amiss. I get them in the football
hold w/ baby very far back so that when he latches, his chin is deeply into
breast, cheeks close and touching breast, and nose tipped back. Make sure
baby is "melted" into mother, i.e. very close. Have mom hold her breast sort
of towards baby to keep it from jiggling and slipping out. Many moms hold
breast kinda pulling it back. I think of it as holding the sinuses close to
baby's mouth. Support baby securely so babe doesn't relax and let the breast
slip out. If mom has low supply or slow letdown (due to pain) then
supplementing at breast may encourage baby to suck better and extend tongue
for deeper sucks. I hope you can use some of this.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, USA



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