I have permission to post. I saw a mother today for the second time. Fist time I saw her, her baby was 4 months old, mom was having trouble weaning from a nipple shield, perceived/possible low supply, and with fussiness outside of feedings. During that consult we talked about deep latching mechanics, latching without the shield, allowing baby to end feedings, observing output, and comforting techniques. Today her apt was to trouble shoot bilateral nipple damage. Each breast has a small open area in the very center of her nipple, both areas bleed quite a bit when they are first opened, and I am sure this is r/t her DX of VonWildebrands. Mom has no evidence of thrush, and has been using APNO whenever her skin opens (BTW, this is the 4th time this has happened, since I saw her 2 months ago, she said that she was embarrassed to call). Here is their history as I know it:
Mother: Dx- VonWildebrands, instructed to pump after delivery to “get things going”?. Saw another LC x2 for nipple pain at weeks 1.5 and 3, instructed on use of nipple shield, unfortunately. At 4 months was not able to stop using shield and concerned about supply and weaning from shield, this is when I saw her first, she was able to start nursing without the shield within 1 week of her visit, and supply has increased, and is satisfying infant.
Baby: Gaining weight normally, happy, no more crying. No tight frenulum (under tongue or to either lip). Palate feels normal, no high arch or bubble. Lots of audible swallowing throughout feeding. And no distress noted during times of milk ejection reflexes. The only thing that I saw that might be problematic is how “wiggly" baby is at the breast. I am stumped. Please help me think of things that I may have missed…..and Lord, please don’t let it be obvious!
Warmly,
Paula Fitt RN, BSN, IBCLC
Newton, New Jersey
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