PTP:  Mother reports her 10 mo old, exclusively BF baby, bit her 6 weeks ago.  She noticed a small crack then at 12:00 at the base of her R nipple.  (I have a couple of good photos with PTP which I will try to post to the Lactnet Face Book page, if that doesn't work, email me privately.)  As the wound got larger with continued Bf & pumping (she works 3 days/wk) BF became excruciating.  Baby does not take a bottle well at day care (usually only takes one feed at day care & then does marathon nursings with mother.)  Baby weighs 19# & is on the 37th% on growth chart for weight.  A few wks ago she started using APNO & felt it helped a bit with the pain (now just barely tolerable to nurse) but no change in size or signs of healing.  She is determined to BF for a full yr (2 more mos) & is desperate for ideas to get there.  I can think of many ideas for topical treatment (Medi-honey, peppermint gel, virgin coconut oil, etc) but how can she keep the wound edges approximated to allow healing?  Here were my suggestions:
1.	See her HCP ASAP for assessment & possible antibiotics as she may have a bacterial infection
2.	Pump exclusively on that side with a different size flange (larger? smaller?) & see if the wound does not gape open further while pumping.  She is reluctant to do this as baby does not take a bottle well, he just loves to nurse.  She has experimented with a cup & I suggested using a cup more often.
3.	Try a nipple shield?  Sized to prevent further widening of the wound.
4.	Use Op-site to try & cover & keep the wound edges approximated while pumping.  Can’t try this while nursing as baby’s mouth would cover the area.
5.  Wean from that breast & continue to nurse on (L).  Mother states she doesn't think she could produce enough for baby.

Oh wise ones...other ideas??

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