Dear Wise Ones, I'm hoping to find some suggestions for a new patient (who picked me after we met at a LLL meeting!) Mom is 44, this is her second baby, first is 7 1/2 now and was breastfed 1 1/2 years. Baby was born by vaginal birth after cesarean on 3/6/04 at a different hospital than the one where I work. He apparently latched the first time right after delivery, and has been feeding fairly well since birth. He was born at 37 1/2 weeks, though, and mom reports the first few days he was hard to keep awake. Birth weight 7 lbs 6 oz. Discharge weight on 3/8/04 was 6 lbs 14 1/2 oz. Naked weight today (in my office, on a different scale) was 6 lbs 13 oz. Baby has at least 6 wet diapers and at least 5 yellow, seedy stools a day in the last 2 days. Mom complains of severe pain at latch of both nipples, which improves after baby nurses a few minutes. On exam, I noted one of those minimal, tight lingual frenulums we've talked about her recently, and baby sucked on my finger with a rather chomping motion with tongue back and forth over the lower gums. The most notable thing, though, was that mom's nipples are very large in diameter, at least quarter size. Baby was at the breast when I came in the exam room, and when he came off the breast the nipple was flattened, and even larger in diameter appearing. It looked like baby had obtained a deep, enough latch based on how much breast came out of his mouth when he opened his mouth. Remarkably, though, there was no obvious nipple damage other than mild redness on both sides. Baby opens wide to latch on, but his little mouth is small enough that the nipple doesn't clear the opening, even when he's wide open. (Does that make sense?) As a result, baby tends to slurp up the nipple until he obtains a deeper latch. Mom about levitates off the chair during this process, but is comfortable once he's settled on. Although his weight was a little worrisome, he is not even slightly jaundiced, is very vigorous, and with his current output I'm guessing he's going to start gaining. (Will of course weigh him again, soon.) I went ahead and clipped the frenulum although I wasn't sure it was causing a problem. Baby then latched at breast again readily for me, but again just can't open wide enough to get around these nipples in one fell swoop. WE tried again in football hold, and had a little better result as mom could see the breast and his mouth better, but still it was hard to avoid scraping the nipple along his gums as he latched on. The baby is very agressive at latching on. I'm guessing a less aggressive baby would not be able to latch at all. Mom also tried once to pump at home with an Avent Isis and found the pump very painful, I'm guessing because the diameter of the shield is too small. Finding any better pump around here is an ordeal, and mom is willing to continue at breast so will not pump for now. She doesn't remember having this hard of a time latching her older child. I'm guessing that this might improve as baby grows, but is there anything else I can suggest to her in the meantime? She's going to try some ibuprofen, the football or cross cradle hold to help her guide the latch a little better, and deep breathing until baby is on well. Maybe also, the frenulum being clipped will help a little? What else can I tell her? Jennifer Tieman Family Physician Mom to 4, including nursling Caroline Rose born 5/31/03 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html