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Thread: Compressed nipple; cracks not healing; latch retraining?

  1. #1

    Default Compressed nipple; cracks not healing; latch retraining?

    Here's the situation:
    • cracks at base of nipple (where her top lip goes) appeared a day or so after she was born. They have not healed, but are not bleeding and do not look infected. I've tried APNO (for the last six weeks), air drying, soothies, you name it.
    • Latch has always been extremely painful due to stretching of the cracks. The pain tends to lessen about 30 seconds into feedings, but;
    • for the last two weeks the nipple ends up symmetrical but compressed with a ridge after feedings. This was after I did a major review of latching (nipple was often lipstick shaped for the first month).
    • I have a fast letdown and sometimes she chokes. the IBCLC said her sucking was 'disorganized', but she generally stays on the boob and manages the flow, pausing for breaths once things slow down. But she's not very gassy/fussy and her poops are almost always yellow and she's gaining fine.
    • Pediatrician says she has 'milk tongue', not thrush; IBCLC and other CLCs have thought maybe there is thrush. The midwives gave me an Rx for nystatin which I haven't picked up since they seemed completely clueless about boobs. I don't have radiating pain or any of the other symptoms of thrush.
    • I can't get her to open her mouth any wider than it already is and I've been told the latch looks great; but as she feeds she clicks/moves her tongue and seems to end up having a shallow latch. Sometimes the clicks themselves are painful as she pinches the nipple with her tongue; sometimes they're not painful.
    • I've tried taking pumping breaks but can't manage it longer than 48 hours before I miss BF and feel disconnected from my daughter. I also worry about not being able to pump enough to satisfy her hunger.
    • We have an appointment on Wed with a tongue-tie specialist.


    My worry is this: if tongue tie is not the issue, how can I retrain her to keep her latch properly/use her tongue correctly? The sensation I have when she is on is similar to when I pinch my nipple, rather than when I pinch the areola. Is this even possible after 6 weeks? I've been dealing with the pain because she's hungry and I want her to eat, but it's taking a huge toll on my sanity and my husband (who is super supportive) can't understand why I'm doing this to myself. I'm worried that I have inadvertently rewarded her for the shallow latch and have now ruined our BF experience.

  2. #2
    Join Date
    Mar 2006
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    10,440

    Default Re: Compressed nipple; cracks not healing; latch retraining?

    My babies have all done that to me. And if it doesn't hurt after the 30 second sizzle, I've gone with it. Mine is from the fast flow, and my babies coping with it. They grow into things with time.

    None of mine had TT.

    And I did go on to nurse my older three kids for years so I doubt you have ruined anything.

    Have you tried maybe clotrimazole on the cracks, just to make sure it's not thrush?
    Susan
    Mama to my all-natural boys: Ian, 9-4-04, 11.5 lbs; Colton, 11-7-06, 9 lbs, in the water; Logan, 12-8-08, 9 lbs; Gavin, 1-18-11, 9 lbs; and an angel 1-15-06
    18+ months and for Gavin, born with an incomplete cleft lip and incomplete posterior cleft palate
    Sealed for time and eternity, 7-7-93
    Always babywearing, cosleeping and cloth diapering. Living with oppositional defiant disorder and ADHD. Ask me about cloth diapering and sewing your own diapers!

  3. #3
    Join Date
    Jun 2009
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    5,584

    Default Re: Compressed nipple; cracks not healing; latch retraining?

    Lots about this sounds like tt to me, although of course Susan is correct, a painful compressing latch could occur with no tt. But you will find out on Wed. Even if it IS tt and baby is clipped, there is likely going to be a time of encouraging baby to latch deeply and comfortably anyway. So, be prepared for that. If it IS TT, even if latch still hurts post clip, you will know the physical barrier has been removed (probably) and you and baby can get down to the business of figuring things out together.

    Do the cracks ever scab over? Are they starting to heal but being reinjured or really simply never healing? What healing measures have you tried?

    If it is thrush, if you are going the oral meds route, you probably want to consider Fluconazole, not Nystatin. Nystatin is effective about 30% of the time and Fluconazole 100% according to the book Breastfeeding Answers Made Simple. Plus baby would have to be treated as well under most effective treatment protocols. However, thrush is seriously over diagnosed and your pain and cracking suggest poor latch, not thrush, to me. However, both could occur at the same time of course. Here is Jack Newmans’ thrush protocol FYI. http://www.nbci.ca/index.php?option=...tion&Itemid=17

    have you tried laid back positioning, does anything help make the latch feel at least a bit better?

  4. #4

    Default Re: Compressed nipple; cracks not healing; latch retraining?

    Thanks - the cracks are just open. The scabs disappeared about four weeks ago and now they're just open, not bleeding, but not closing up or filling in. The cracks are about 6 mm long and 3mm wide. I've been using APNO, lansinoh, normal saline, I did a few days with soothies but it just seemed to squash the crack together and then it would get pulled when she nursed. I've been sleeping without a shirt or in just a light shirt at night the whole time. I've now been using those breastshells during the day for 5 days. I tried a shield but it didn't seem to help much and if the nipple isn't already stretched the silicone rubbing on the crack is murder when she latches.

    I am also hoping it isn't thrush (one reason I have delayed picking up the Nystatin, along with what PP mentioned above). Different latch positions don't seem to help with the latch pain, although I use cross-cradle to latch her 99% of the time because I can see what I'm doing. Clutch/football doesn't work well when the letdown is fast.

    I started looking at lip-tie also; when she sucks my pinky her top lip comes under (and when she nurses I can never get her top lip flanged out, and it just 'works' the whole time, like she's munching). But the ENT can look at that too I guess...

  5. #5
    Join Date
    Jun 2012
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    46

    Default Re: Compressed nipple; cracks not healing; latch retraining?

    I could have written your post myself! I have the same concerns, especially that my baby has now learned a shallow latch (he does manage to get some milk this way but it takes more effort) and I don't know how to retrain him. My baby is also 6 weeks old and I was in serious pain for the first 2 weeks, we did introduce a bottle and pumping though so I'm not in so much pain now (but not bf that much either).

    He did have tongue tie diagnosed 3 weeks ago and had it clipped, but last Friday we were told scar tissue had formed and he needed to have it done again. I am now really worried the same thing will happen, as I'm sure you can't keep operating I haven't seen any improvement, in fact his latch seems to have got worse, although that could be due to us becoming increasingly reliant on bottles and not practising enough! I wondered about lip tie, because he tucks his bottom lip in while nursing, although he can flange it out when sucking a finger...

    Keep me posted, I will be interested to hear how things go for you, and good luck

  6. #6
    Join Date
    May 2012
    Posts
    88

    Default Re: Compressed nipple; cracks not healing; latch retraining?

    Sorry to hear of the pain - I dealt with some similar issues early on so I just wanted to add that what helped me with the cracks / nipple damage was a little bit of organic coconut oil. It is safe for baby, is soothing, goes on easy and is healing (as opposed to lanolin which is just pain relief). I think it has antibacterial properties, too.

    I swear I don't work for a coconut oil company. I just thought it worked better than the other stuff so I try to tell other suffering mamas about it!

    Also, if you can keep on top of encouraging a good latch as you're doing, your LO can get better at it as they get older. Often as they develop and their mouth gets bigger, they also learn better coordination and how to draw milk and swallow better. This certainly happened with my LO over time, who in the beginning did a lot of flutter sucking and sometimes too-shallow latching. He was checked for TT by a specialist but that was thought not to be the issue.

  7. #7

    Default Re: Compressed nipple; cracks not healing; latch retraining?

    OP here - we had her posterior TT clipped on Wednesday; the ENT didn't think the lip-tie was a problem ("something for the dentist to take care of later, when she gets her adult teeth"). It's a bit early to really tell but I think her suck is slightly more comfortable and less pinchy (although just as shallow, it seems), once the initial latch pain has gone (that definitely has not changed!).

    My IBCLC also recommended trying coconut oil, but honestly at this point I think it's something mechanical that is keeping things from healing (it just seems impossible that there's some microbe that the coconut oil would kill that the APNO, saline, etc can't, and the one microbe is preventing healing). So I am waiting for her mouth to get bigger, I guess.

    I think there is some disagreement on whether lip-ties should be cut or not, so I'm still looking into that.

    thanks for all your help!

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