I am working with a mother whose baby is currently 3 weeks old. She was
born at home with no complications. This is her third baby - the first two
were twins who were breastfed with no problems.

After one week the mother had a cracked nipple on the one breast and a lot
of pain while feeding. We corrected the latch significantly and things
seemed to improve for a few days. The crack though was not healing - not
getting any worse, just not getting any better - and the pain was getting
worse.

The mother saw another lactation consultant as we felt we had tried
everything at home. The baby was diagnosed with a high arched palate. The
baby's latch is good. For two days the mother expressed EBM and the baby
was fed this together with being breastfed by a friend regularly to give
the mother an opportunity to rest her nipples. The mother then began using
nipple shields after 2 days to reduce the pain and allow the crack to heal
more effectively. At the same time she began to express milk to keep up
supply and the baby was supplemented with EBM only after a feed was given
at the breast and she appeared to be unsatisfied. The baby is gaining
weight well and is satisfied.

My question is, in your experience, how long does it take for a baby with a
high palate to begin to "grow into" the palate and the mother is then able
to stop using the shields? Feeding without the shields is still very
painful so the mother is persisting with these. She has a good milk supply.

My second question is that the mother has herpes simplex 1 and developed a
cold sore a few days ago. She now has two small blisters at the top of one
nipple. She has been feeding the baby for 2 days with the shields on and
the blisters being present so the baby has already been exposed to the
virus. We do not live in a community where the doctors are very
breastfeeding friendly so do not feel we woudl necesarily get accurate
information on feeding in these circumstances. Is acyclovir the correct
treatment for the baby in such cases? And if the baby has already been
exposed to the virus is there any benefit to stopping feeding from that
side?

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