Hi All,

I need some advice from the experienced body:

I have a client that is experiencing pain during feeding. Her baby is 5.5 weeks 
old. When I first saw her, she presented with cracked nipples with stage 2 
damage. Mother was latching the baby very nicely using the assymetrical hold 
and baby looked great while feeding. The mother stated the latch was not 
painful, but about 30 sec. into the feed she could feel the nipple slip and she 
would experience pain for the rest of the feed. If she took the baby off and re-
latched, it would happen all over again. 

On examination I noticed that the baby has a very high palate and I suspect it 
is a bubble palate. There is no evidence of tongue tie. 

We tried many different ways to help get a deeper latch and position to keep 
the nipple deep in the mouth. As this mother was experiencing a lot of pain, I 
introduced her to a nipple shield which gave some relief to the point of 
allowing the mother to feed and bear the pain. She also was given info on 
using APNO as I felt the nipples looked like they may have infection.

The next week I saw this mother and her nipples were almost completely 
healed. She had been using the shield for all feeds for about 4 days, as she 
was unable to bear the pain. We worked on latch again and mother was able 
to feed with only slight pinching, in what seemed to her, to be on the areola 
under the tongue. The nipple had slight compression in a lipstick shape but 
backwards, so that it looked like the bottom of the nipple was being pulled in 
enough but not the top (opposite to a shallow latch mishapen nipple). 

The mother had also been to a chiropractor to have a cranial-sacral 
assessment and treatment and felt that the baby had been latching better 
since. The C-S therapist told mother that the palate did not seem too high to 
her. Since the nipples were healing well and mother had been able to latch 
and feed in relative comfort I decided perhaps I was wrong about the palate 
and maybe the nipples just needed time to heal and everything would be good 
for this mother.  We made an appointment for 2 weeks later.

This last appointment, the mother presented again with extremely sore 
nipples. There is no evidence of cracks (thank goodness) and she is still using 
the APNO to minimize the risk of infection. She has gone back to using the 
shield for most feeds because she says that if she goes a whole feed without 
it, the pain is too much for the next feed. She latched again during the visit 
and is experiencing the same pain and mishapen nipple. I've tried different 
positions (some unconventional) in an attempt to get the top of the nipple 
into the back of the mouth with no success. I'm still suspecting a bubble 
palate causing the top of nipple to slip back into the palate and be pinched.

I'm at a loss. The baby is gaining beautifully and mother doesn't want to quit 
because she sees how well the baby is growing. 

My question is: Has anybody worked with a mother with this difficulty. Does it 
get better as the baby grows? I know nipple protactility can play a part in this 
and this mother's nipples seem quite supple (for a primip). Does anybody have 
any tips or tricks to offer?

Thanks,
Karen Nielsen BScN RN IBCLC RLC

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