Andrea, when nipple damage is this bad, and has gone on this long,
correcting the latch, an making sure there are no oral anomolies (like a
tight frenulum or tight labial frenum) is essensial. (Of course it is
essensial whether there is severe damage or not!) But almost without
exception, this type of damage involved bacterial infection. Healing will
not take place, even with corrected latch, if the bacterial infection is
not treated. Topical antibiotis usually are not enough (although Dr.
Newmans three in one ointment often gives moms a great deal of relief, and
I start them on it immediately) I usually talk to the mother's doctor about
starting her on Dicloxiclian, or Cloxicillan. (sp?) which is a great abx
for these types of problems. Usually with corrected latch, three in one
cream (which will also help if there is a fungal component as well) and
oral antibx, these moms will do better in a short period of time.
Ibuprophen can also give these moms a LOT of symtomatic releif. Most of the
docs I know will prescribe 600 mg or 800 mg for this condition. Also doses
of OTC ibuprof can be used. In rare cases Vicoprofen is used, as the pain
is sometimes overwelming.

I *rarely* take babies off of a sore breast, but when I do, it is usually
for not more than 12-24 hours, making sure she has a hospital quality pump,
and is draining the breast at every feeding. I also recommend sterilizing
the kit after each pumping, as to not spread the bacteria. (Medela's quick
clean, microwave bags are perfect for moms in this situation. I have no
financial interest in this product, it is just convenient and works.)

We want to treat these moms before mastitis sets in, as that is usually the
last straw, and often will persuage the mother to simply stop nursing.
Often with this type of nipple damage I see mottling and heat on the breast
before any fever or other sx of mastitis, so antibiotic treatment is
usually a good idea.

Mary Jozwiak IBCLC, RLC, AAPL, LLLL
Private Practice

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