Kathleen, Here is my armchair analysis, for what it's worth: If the part about the palate is true, combining that with the baby's "tight" mouth would indeed account for a lot of the initial pain and damage! [Had I seen all of this, I may have taken the baby off the breast in the very beginning, pumped mom, and done fingerfeeding to train the baby's suck until the tightness relaxed--- I had a mom I've just finished working with, and her baby just clamped down very tightly once you got something over the tongue, which loved to stay up; mouth did relax with alternate feeding, but unfortunately mom just gave up getting back to breast before seeing me again-- company interference with appts] From there, it is no surprise that thrush was able to set in, and of course after that came the contact dermatitis problem. Poor woman! A tight mouth, too much pressure with compression, whatever you call it, needs counter pressure to help. Sometimes this can be done against the jaw, but the last time I saw this done the baby hated it. Otherwise, baby may need to be taken off breast :( and suck trained with a finger, which can apply counter pressure during feeding without injury. Also, damage from this type of pressure can result in a radiating pain such was described. When you mix thrush pain and nerve damage, it can be difficult to see what is what at first! (hindsight is always 20-20, isn't it?) As for the palate issue, if it stood alone, I would have put mom and baby into a position that placed baby above the breast rather than allowing the breast to hang by gravity into baby's mouth. This forces baby to be active in the nursing process, and baby is "forced" to take more tissue into his mouth in order to get an adequate hold on the breast! My favorite position: mother supine, baby on top in prone position. After L-O, baby can roll slightly to one side. Also, finger feeding is good for palate issues because the baby wants to pop the nipple into the bubble rather than taking it farther back, and finger feeding "desensitizes" baby to having something farther back in mouth. The initial problem is that such babies may gag at attempts to put more tissue further back..... I'm not as sure about the pumping situation, and am unclear from your post as to which double pumps she was using. I have seen that thrush can make pumping very painful, and sometimes manual expression is the best choice. At any rate, had she taken baby off the breast sooner, before extensive damage, I'll bet a lot of this wouldn't have happened. I don't love to take babies off the breast, but if we can't get breastfeeding to a reasonable degree of comfort pretty quickly, I will not allow a mom to get torn up like this; problems don't get solved this way. At least now she knows what products to avoid. She might consider doing a patch test for lotrimon in case she faces yeast with another baby and needs a treatment. At this point of weaning, I personally would handle it differently in that I would not encourage this painful nursing. Rather, I would encourage her to go back to a pump once she is healed (she's almost there, right? or am I off track here....). If she was using the Medela double system, take the blue silicone ring off to decrease the suction pressure if it felt/still feels too strong. Then pump and finger or bottle feed baby. If she had it in her, and I can understand that she doesn't now, I would just have her pump, slowly build supply back up, and allow those poor nipples to heal completely. Then, when baby's mouth has begun to relax, try again to get baby to breast using "bubble palate" positioning strategy. Kathleen, this is kind of sketchy and jumps around; it's all I have time for, but your story hit some points with me. Tell me what you think of my analysis, and I'm looking forward to reading others. :-) -Lisa