I have consulted with >2 year old with sudden development of sore nipples, damage, etc.  The culprit was ...wait for it ....   LATCH!  The toddler was sitting in mom's lap, shallow toothy latch.  When mom reclined and had child across her lap with weight born on mom's body rather than legs, "voila" - problem solved.  It did take a while before child was willing to comply, but mom was able to continue.  
Also - with a deep crevice, oral antibiotics may be required.  Topical may not penetrate. And I believe there's an article in JHL that recommends this based on a study.  Can't recall author - but think it was Verity ???  Don't have time to research today.

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Lea Rivera Todaro
Sent: Tuesday, February 08, 2011 10:43 AM
Subject: Nipple damage after 14months of breastfeeding

Esteemed LactNet Colleagues,

(does that get me around the filter?)

Permission to post:  I fielded a phone call from a second time mother.  The child is 14months old and was exclusively breastfed till 6 months.  Child is still feeding 5 times a day for 5 minutes each time.  Child is teething.  About 3 weeks ago the mom's menstrual cycle returned and she had a dip in supply.  The doula she had used for post partum care recommended pumping every 2 hours to increase/maintain supply.  She has a Medela pump that she used for her older child and she stated that she did "pump badly" which she explained as "I had it cranked all the way up."  She also is taking fenugreek.  I don't know why, but she says she's always been concerned about her supply.  Anyway,  the nipples - according to mother - are badly split and extremely painful.  Her midwife, whom she saw late last week, gave her a prescription for antibiotic ointment that she has been using for 48 hours.  She doesn't see any real change, but it may be too soon. 

So, my thinking at this time (I haven't seen her) is that she caused some damage to her nipples during the pumping, which may have gotten infected because of the child's teething or some other vector (like an old pump).  The question I have is -- aside from basic wound care -- does anyone have a tip for what to do with the toddler?  The child isn't open to bf'ing off one side only.

Thank you all!

Lea Rivera Todaro, IBCLC

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