HI there. I would give her a copy of Jack Newman MD's protocol for
Candida as well, and try some of those things. The APNO ointment would
be a good start. Sounds like there is something up with the baby's oral
anatomy, perhaps? What kind of pain is it?
Dear Lactnetters,
I have a situation that I'm hoping someone has some good ideas for.
8 week old baby, thriving on breastmilk and breastfeeding, however mom's
nipples are still extremely painful and pinched whenever baby comes off
the breast.
They initially started out cracked & bleeding, we worked on the latch &
positioning and breastfeeding seemed to progress and the nipples healed.
However, nipples continue to be pinched after feeding and *very*
painful. They look purple-ish. They don't really look yeasty; however
the OB did prescribe Diflucan and gave mother a 1 month supply. Baby
shows no yeast symptoms and was never treated.
Mother has been using a shield off and on on the left side (mostly on)
because of the pain, but for the last 3 days has been using the shield
on both breasts because of the pain. Her nipples are not pinched with
the shield when he finishes and he transfers milk effectively with or
without the shield. At this point the shield is mostly for mom's
comfort.
Baby's tongue does not cup finger nor extend past gumline on digital
suck assessment, yet baby's tongue is able to elevate and extend well
past the gumline. Mother uses very good latching and positioning
technique and latch
*looks* perfect, yet the nipple is always pinched. The only position in
which the mother has found no pinching is when she is lying on her left
side and pretty much propped over the baby and offering the right
breast. He got a *good* mouthful, she says and her nipple wasn't
pinched. The bad part was that the flow was so great that the baby was
choking and it was very uncomfortable for mom.
We talked about possible Raynauds but neither of us feel that is really
the problem. We don't believe it is yeast either, but we acknowledge
that it could very well be. Mom has been taking the Diflucan for 1 week
with no improvement, but again baby hasn't been treated.
Since the nipple is pinched after feedings, that leads me to believe it
is still a nipple trauma issue, but I suppose that yeast could be an
underlying problem which is just exacerbating the situation. Baby does
not appear in any pain while feeding and again shows no signs of yeast,
either oral or diaper area.
Baby's weight gain is stellar and mom's supply appears neither low nor
excessive. Baby has an appointment with the ped tomorrow and mom will
discuss with the ped treating the baby for yeast. I gave mom a copy of
Pat Gima's yeast treatment plan and info from The Breastfeeding Atlas so
that she can decide what else she wants to do regarding possible yeast.
My real question, I guess, is what else can we do about the latch. She
is using a good asymmetrical latch, I don't know what else to try,
except keep working on it and use the shield when necessary, and try
different positions. We discussed ways she could make the lying down
position comfortable for her since that one resulted in no pinching. We
also discussed some other non-traditional positions. Any ideas?
Thanks in advance.
Cindi Swisher, RN, IBCLC
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