A few things stand out:
1. Has this mom/baby ever been seen in person? Could be a latch problem.
Mother needing positioning help and/or baby with anatomical issues. Also how
is mom "managing" breastfeeding. If not explored with her, she may have been
advised to do something counterproductive to good bf practices.
2. At 3 wks, engorgement? and oversupply? This could still be the root of
the problem.
Again, could be a latch problem? Tongue tie? The next week is when the
cracks started, was baby clamping down?
3. Is mother doing any pumping? Was she pumping early on? So many mothers do
and try to manage engorgement but make it worse, or pump for 'relief'
bottles, or for back to work plans.
4. Possibly this mother needs to express by hand for 1-2 days and cup feed
the baby to let her nipples heal somewhat? Then she needs an in person
consult.
I like for the mother to gently was the nipple wounds (does she still have
visible trauma?) with mild soap and water and with very clean hands, several
times a day.
5. Possibly this mother needs oral antibiotic treatment. I see mother did
have some treatment, not sure what med and what dose. Perhaps not treated
fully.
6. Plugs continue to occur, so could be subclinical mastitis or still
oversupply or more likely to me, sub-optimal latching and draining of the
breasts.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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