Dear excellent LCs :),
    This morning I had an in-home consultation with a mother who is a
pediatrician from one of my main referral practices.  First baby, 5 weeks
old, the mother is in PAIN during and after breastfeeding.
    Since a pediatrician with a good nursing experience is a great advocate
of breastfeeding, and because I hate to see any mother in pain, of course I
wanted to "fix it" for her.  Unfortunately, her baby chews the breast.  The
chewing is intermittant, about 50% of the time.  It can occur at any time of
day, at any point in the feeding, and on either breast.  It began on day 1
and seems "about the same" to the mom, now 5 weeks later.  Of course, her
nipple becomes pinched and bloodless (the blanching again) when the baby
chews, with rebound hyperemia and burning when the blood vessels dilate after
nursing.
    This baby also swallows a lot of air, and needs to be burped every few
minutes.  The burps are really impressive!  Related?
    This little girl also has congenital heart disease which will require
surgery at about 30 pounds, but has no signs of any compromise related to
feeding--stays nice and pink, no significant respiratory effort, etc.
    Things I've suggested to this mom to try for the "chewing":
-Say NO! and take her off when she chews.  When she goes on correctly, smile
and give praise
-basic good positioning
-try gentle support under chin to stabilize jaw
-try gentle downward pressure below lower lip
-try nursing with baby prone
-try massaging TMJ before and/or during breastfeeding
-massage, music, etc for general relaxation
-time....as I usually see this gradually ease up beginning 4-6 weeks of age

    We've considered thrush in case baby was chewing  to try to "scratch
itch" in her mouth, allergies, but not likely in this case.
      What else???
     Debi Ferrarello, RN, IBCLC
PS-I asked her about brick dust urine.  She said that IF everything else
looked good, she wouldn't worry about it even in older baby.  Still no
reference....