I seem to be seeing quite a few moms recently with sore
nipples that basic positioning doesn't fix.  These are moms
whose nipples are wedge-shaped after a feeding.  There is a
compression stripe (white area across the middle of the
nipple) when baby comes off the breast and sometimes a row
of what appear to be tiny blisters at the tip of the wedge.
The blisters tend to go away slowly after the feeding.

I talked about one of these cases with Alison Hazelbaker
during the ILCA conference this year.  She stated that
clenching was the cause and suggested craniosacral therapy.
Another consultant who attended a lecture by a speech
therapist suggested referral to a speech therapist.
However, neither of these suggestions is a realistic option
in most cases in the environment in which I work.

As a result of reading, talking to others, and
experimenting, the strategies which seem to help at least
some of the time are swaddling the baby in a flexed position
to help him/her relax, encouraging the mother to feed the
baby at the earliest sign of hunger, applying gentle
downward pressure on the chin during the feeding to prevent
clenching, and stopping any practices which may have
contributed to the baby's clenching in the first place.

I know that epidurals have frequently been faulted for
causing clenching.  While this may be the case, I wonder
whether the actual cause in some cases may not be the
epidural itself, but medical practices resulting from the
epidural or from other factors.

The factors which I am beginning to theorize may contribute
to this behavior (based on the histories I have elicited
from the mothers of babies who clench) include aggressive
awakening techniques (cold wash cloth to face, flicking
feet, etc.), force feeding with bottle and/or at the breast
(pushing upward on chin during bottle or breast feeding,
pushing in on cheeks during feeding) and  the baby get too
hungry (not offering the breast because he just ate, feeding
cues ignored because mom requested baby be kept in the
nursery so she can sleep, infant breast refusal  because of
noxious oral stimuli or any of the factors previously
mentioned).

Am I way off base?  What are your experiences and theories?

I am wondering if I am seeing this more often because it is
happening more or because I am more aware of it.  I think I
have ignored it to some extent in the past because I didn't
know what caused it or what to do about it.  In such cases
my strategy is try the basics:
Correct the mother's position
Correct the baby's position
Correct the latch
Try the other breast
Try other positions.
I find the above fix most problems or at least lessen them.

Please reply privately as well as to the list; I doubt that
I will ever catch up or keep up.  TIA.
--
Bonnie Jones, RN, ICCE, IBCLC  from the sunny S.W. USA
mailto:[log in to unmask]

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