Permission to post....

I have a client whose baby is 12 days old.  This is her 3rd child.  With her first two kids, she exclusively pumped for 7 months b/c her babies wouldn't latch (now realize that they were tongue-tied.)  However, the persistent problem was that her nipples would not heal for the entire 7 months that she pumped.  She used APNO cream, lanolin, diflucan, and saw a dermatologist, but to no avail.  

Now, with her 3rd baby, she was cracked within 10 hours after birth.  The baby's tongue was clipped at DOL3 and she started CST at DOL4.  The baby's suck is improving, but her nipples are a mess.  Both are cracked in several places.  The tips are raw and bloody.  She has tried coconut oil and lanolin.  She is not anemic.  Last week I recommended biotin (15mg) and zinc (60mg) per day, but she just purchased it today.  I also got her larger flanges for her pump, which she is using at the lowest suction setting.  Baby is feeding with a nipple shield.  I cannot figure out why her nipples won't heal.  She is in terrible pain, but is very dedicated to breastfeeding.  What am I missing?  What other remedies could she try?

Thank you!

Robin Kaplan, M.Ed, IBCLC
San Diego Breastfeeding Center, LLC
www.sdbfc.com

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