I have permission to post regarding a client who's baby is 5 months old and has been exclusively breastfeeding.  While in the hospital, mom
developed small cracks at the base of her nipples which healed completely within the first two weeks.  Mom was applying Lansinoh, polysporin 2
x's day along with improved positioning. She has a somewhat overactive let-down with perhaps some overproduction, which has been manageable
by nursing on only one breast at each feeding.  She leaks a lot.  Always needing breast pads.

Approximately 3+ weeks ago she developed these cracks again and cannot seem to get them to heal.

The baby was in the hospital a week before this with RSV.  Mom stayed the two nights while in the hospital to nurse.  Baby was treated with
antibiotics and mom stated baby had been fussy and gassy since home from the hospital. During the consult, I noticed the baby had a few white
spots in her mouth and moms nipples appeared red, with reddness on part of the areola also.  I encouraged her to see her doctor for diagnosis
and treatment if necessary for thrush. I also gave her information about GV, yeast/thrush from Jack Newman and Pat Gima.  Mom decided to
start with GV, vinegar rinses and polysporin as well as diet improvement. She said baby seemed less fussy and gassy, but mom was not any
better. Mom and baby went to dr. and was given Newman's APNO, and Nystatin.  Mom spilled half the bottle of Nystatin, had enough to treat
baby for 7 days, baby seems fine, but mom's nipples are still cracked.  Mom used NPO for up to 10 days as recommended in BWC's/KH's
Breastfeeding Atlas as well as applying Nystatin to her nipples.

She does still wear pads for leaking.  She tried changing pads more frequently to stay dry.  With the pads the nipple does fold into the crack.  I
suggested perhaps wearing shells to keep the nipples from folding in and pulling open repeatedly.  She said she leaks even more so with the
shields (which I did address beforehand with her and gave suggestions such as using pieces of cotton flannel at the bottom of the shell to absorb
milk).

What am I missing?  Thank you.  Mary Coutts, LLLL, IBCLC

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