Lou

Ouch!  Sympathies to the mom. You've already
given some good ideas. In my experience fissures
don't close/stick together as you'd want them to,
so that they can heal.  So trying to stick the
wound shut after every nursing is
counter-productive because you then have the pain
of it opening all over again. In fact a fissure
heals _open_ and this has the effect of
lengthening the nipple a little.   Just let it
be.  Use a little cup over the nipple/areola
inside the bra so that there is no compression in
between feeds and so that it can air-dry.  I'd
check for a bacterial infection too.  And try and
position the baby so that the corner of her mouth
is nearest the site of the fissure, this reduces
the stretching which can occur if the tongue or
upper gum is sited over the sore area.  If using
the pump use the side of the pump to splint the
nipple a bit, so that it's not quite centred in
the flange - this will reduce the stretching.  Or
hand-express to eliminate stretching
altogether.  But it needs to heal open, from the
base of the V upwards.... unfortunately.

Good luck.

Pamela Morrison IBCLC
Rustington, England
------------------------------------------------
Date:    Fri, 18 Apr 2014 07:46:42 -0400
From:    Lou Lamb <[log in to unmask]>
Subject: Nipple fissure

PTP:  Mother reports her 10 mo old, exclusively
BF baby, bit her 6 weeks ago.  She noticed a
small crack then at 12:00 at the base of her R
nipple.  (I have a couple of good photos with PTP
which I will try to post to the Lactnet Face Book
page, if that doesn't work, email me
privately.)  As the wound got larger with
continued Bf & pumping (she works 3 days/wk) BF
became excruciating.  Baby does not take a bottle
well at day care (usually only takes one feed at
day care & then does marathon nursings with
mother.)  Baby weighs 19# & is on the 37th% on
growth chart for weight.  A few wks ago she
started using APNO & felt it helped a bit with
the pain (now just barely tolerable to nurse) but
no change in size or signs of healing.  She is
determined to BF for a full yr (2 more mos) & is
desperate for ideas to get there.  I can think of
many ideas for topical treatment (Medi-honey,
peppermint gel, virgin coconut oil, etc) but how
can she keep the wound edges approximated to
allow healing?  Here were my suggestions:
1.	See her HCP ASAP for assessment & possible
antibiotics as she may have a bacterial infection
2.	Pump exclusively on that side with a different
size flange (larger? smaller?) & see if the wound
does not gape open further while pumping.  She is
reluctant to do this as baby does not take a
bottle well, he just loves to nurse.  She has
experimented with a cup & I suggested using a cup more often.
3.	Try a nipple shield?  Sized to prevent further widening of the wound.
4.	Use Op-site to try & cover & keep the wound
edges approximated while pumping.  Can’t try
this while nursing as baby’s mouth would cover the area.
5.  Wean from that breast & continue to nurse on
(L).  Mother states she doesn't think she could produce enough for baby.

Oh wise ones...other ideas??


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