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Baby is 13 months old, history of labial and tongue ties, both revised early on (4 weeks old I believe), and hx of muscle tightness.  Saw craniosacral therapist 3 times as a newborn, which mom states helped nipple soreness.

Complaint is cracked right nipple for several months now.  Nipple is partially inverted with a pit in the middle noted and a deep crack that is bleeding and extremely painful for mom.

Baby appears to prefer left breast, which has mild pain, but no cracks or fissures.

Mom is wearing gel pads on affected breast and states she is constantly airing them out at home, with no relief.  She has tried a homemade remedy for yeast which she states worsened it (some kind of triple nipple ointment).  Mom will also wear breast shells to help evert nipple when air drying, but states she doesn't wear them when leaving the house because they are so obvious.

She feels that baby may likely have some reattachment at the frenulums, and may need more craniosacral therapy, but is reluctant to pursue this due to time and money restraints.

My primary question is how to heal that crack on her right nipple (and then we can deal with the rest of it!)?  Should she continue to air dry at home and temporarily only nurse from the left side (since her milk supply is obviously well established now)?  If so, should she pump to keep up her supply?  Are the gel pads harmful since they keep the nipple moist, or should she continue them? 

Mom is a NICU nurse and is highly motivated to keep breastfeeding, but she needs some relief!  Any thoughts and advice welcome.  Thanks!  Katie LC Intern

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