----- Forwarded Message -----
From: [log in to unmask] 
To: "Lactation Information and Discussion" <[log in to unmask]> 
Sent: Tuesday, January 29, 2013 10:58:34 AM 
Subject: Re: LACTNET Digest - 28 Jan 2013 - Special issue (#2013-57) 


Hi Isabella. 


Have you done a suck assessment? What is the baby's palate like? I assisted a mother in an outpatient consult who had persistent sore nipples. A suck assessment indicated a high, arched palate. Mother had been diligently aiming nipple to palate, as had been suggested during hospital stay to help guide nipple over tongue. My thought was that the nipple was being bent up into the arch and thus not fully extending into the mouth, getting pinched, and not allowing baby to fully compress the breast in the process. I explained my thoughts to the mother and suggested she still guide over the tongue but aim straight in and not tilt the nipple up and "sandwich " the breast to get nipple deeper into the mouth - and past the arch. Mother noted immediate increased comfort and baby had good milk transfer. 


Cindy Garrison BS IBCLC RLC 
Pennsylvania, USA 

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 


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome