Melissa posted about a 20 year old mum with 9 week old baby, mum with very
damaged nipples and recurrent masitis.

It is always very difficult to know what is happening without seeing what
baby and mum are doing, but a few thoughts come to mind:

1) What is mum's general state of health? You mentioned she was pale -
could she be anaemic? Poor general health can predispose to recurrent
mastitis.

2) Nipple damage and mastitis can go together when baby is not draining
breast efficiently.

3) To do such damage to the nipple, surely there is something wrong with
the attachment. Positioning can be OK but not necessarily attachment. I
have found mothers with large breasts often need to virtually bury the
baby's face in the breast to get good attachment, particularly the baby's
chin, with just enough room for an airway for baby's nose ( ie still not
depress breast away from baby's nose for airway). They also need support
for the breast, usually with mum's free hand with fingers flat under breast
(C-hold). The sling sounds a good idea. How painful is it for her to feed?
Is it the same amount of pain throughout the feed, or does it get less
after MER? Does she get thrush-type breast pain after and between feeds?
From what you said, I think thrush sounds unlikely, but I guess it may be a
contributor.

4) Baby initially sucked in lower lip. This usually causes tongue to be
held further back in baby's mouth. You mentioned that they trained baby to
keep his lip out, but could he still be keeping his tongue back even if he
is not tongue-tied? I hate these sort that seem to need suck training -
fortunately in my experience they are few and far between.

5) Could the nipple shield be contributing to the damage? Does baby attach
well onto the breast when on the shield, or just attach to the teat section
of shield? Does the shield fit the breast, or does it cause friction and
therefore more damage?

6) Could the topical treatments used on the sore nipples be contributing,
perhaps causing a reaction?

Could be way off the track here, but just some initial thoughts. Let us
know how she gets on.

Joy Anderson, IBCLC
Perth, Western Australia