Dear Lactneters
how are you? 
I have a mother here, that I'm not able to help as well.... I hope you can help me :)
I saw her the 1st time when the baby was 10 days ago. She had nipples cracked and pain, the baby latched not well, the tongue was retracted, nipple-confusion and so on. 
We explored all the choices, then decided to finger feed the baby for a while, then come back to the breast. Unfortunately I didn't see her when she put the baby back at the breast. By phone, it seemed all well. She started again to put the baby at the breasts.
After about 10 days , she phoned me because she had newly nipples cracked and started to FF. She was using a drug ointment (Fitostimoline, I do't know the name in America) waiting that nipples were good to start to breastfeed again. I enphatized about positioning and lach on, but she insisted that the baby was sucking well and I had not to see her.
About 1 week after she was again breastfeeding, another breast lump came. in a couple of days it cracked and she felt so much pain to stop again and again FF for 3 days.
10 days after, lumps again, not only one, a lot of pain, she suspended to breastfeed for more days (5-6) to be sure the problem was solved.
She told me too that the baby had his tongue white, and she felt some burning on the nipple, so I suggested to let him see to the pediatrician (candida?).. the doctor was not sure but give her and the baby the drug .
She told me something that make me think to Raynauld too.... so I suggested to try to apply warm to the chest, she's doing that but she tells me no changes happened.
Last week, she put the baby to the breast again, and this time, the pain came immediately, not after some days as in the last times. She felt really upset and phoned me run-down.
Ok, I told, I have to insist to see you, I'm not sure the baby is sucking well, so I go 2 days ago for a home visit.
This is what I saw.
She put the baby at breat in a good way... The baby is positioned well, she make him open the mouth , and do an asymmetrical latch as I teach her, even if she do that too much fast, that is that she takes the breast with her hand and moves it up and down telling to the baby "aaahhhhh".. it seems to me it's too fast for him, but in fact, the latch on definitively is good and he takes in the outh enough breast.. So I don't think this is a problerm, because she hasn't that typical hardest pain at the latch on. She refers when the baby latchs on, she start to feel pain, but the pain **increases** as she continues to nurse.
Lumps are really small. They are small blister, red that pop up for blood  into, during the nursing.  I have some photos if you 'd like to see them, I can send you privately. She tells that if she don't stop to nurse in 3 or 4 days, blisters crack and she isn't able to nurse for the pain. (in any cas,e they always are some painful)
Then we were chatting and about 10 minutes aftert he nursing the nipple top became white and after a couple of minutes pink. :-OO??? No pain related. The granma referred she noted this white several times. No blue. Only white and then pink.
I made an oral assessment ( a disaster, the baby was bored, and it seems he retracted the tongue, but the mother tells me she can see the tongue during nursing, so perhaps it was not the good time , simply) and I noted something really strange, like a keeled sternum, that is that in its back, centred, the palate floor is lower... I saw in Palmer's website about torus, and it seems to me it's a torus, but it's the 1st time for me, I could be wrong :-). I asked the mother to try and have a photo of this strange palate.
I think this could explane some of this mother's problems. But can this kind of palate explain the recurring lumps??
Can this mother have dermatological problems? Or?? :-P
Hugs
Martina Carabetta
IBCLC
Rome-  Italy

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