Hi again, Janet Simpson and everyone!
Just couldn't resist a comment on your scenario of the older breastfed child
and the crack at the base of the nipple on one side only. We see many older
breastfeeding children who change their previous behaviour at the breast
because of cutting teeth, distractibility, mouth irritation from thrush or
food allergy etc - and can sometimes demonstrate an amazing repertoir of
feeding positions, many of which reduce the amount of breast in the child's
mouth to something pathological. (And makes us cringe to watch!)

It is very interesting that the vast majority of the mothers actually don't
have nipple damage as a result of this (well, not enough to complain about,
anyway). But there are certainly some who are suffering with problems such
as the situation you describe. We find that cracks at the base of the nipple
are an indication that the baby is not taking enough breast into the mouth
out from the nipple in that spot, and when the mother encourages the baby to
accept more breast in his mouth out from that spot, she can immediately
notice a drop in the pain levels because there is less "pulling" on the
crack. We also find that when there are cracks at the base of the nipple,
pumping is more painful than improving the attachment and continuing to
breastfeed, because pumping involves a lot more simple suction and pulling
on the breast than does a well attached feeding baby. Itis also fairly
typical that a problem develops on one side only, even when you can see that
the little darling is doing the same appalling things at both breasts -
local nipple and breast anatomy is different and the way we hold and attach
babies is also a bit different with each side, which seems to be why one
side often does not seem to be affected. There is also the difference in
flow rates and baby's preference for one breast over the other which may
affect why one side suffers damage and the other doesn't.

Anne Bovey and Robyn Noble, Brisbane, Australia