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Expert Q&A

	By Ann Calandro BSN, RNC, IBCLC Lactation Consultant

I am at a loss. My son is almost 4 1/2 months old, and breastfeeding is still painful. It has gone up and down on the pain scale and has recently gone up again. My baby has no signs of thrush – he's been checked several times. I have seen three lactation consultants.

The baby did have some latching problems in the beginning, as I have flat nipples. He still does not always open his mouth all the way. My nipples are red and sore and sometimes burn, especially after feeding. It also hurts during feeding – this has come and gone, and now has come back.

Early on (6 weeks old), I had a milk culture that showed no yeast. I have tried gentian violet and Nistatin (however, I used the baby's medicine, and then later used Monistat). The pediatrician feels that if there is no sign in the baby of thrush, there is no reason to treat. At 4 months, there would be some kind of rash or something.

Recently, the baby has been pulling off my breast during feedings. I have assumed that this is due to being distracted and his age. However, he also needs to be burped several times during a breastfeeding, and this only used to happen either between breasts or with a bottle. Also, he has a weight gain issue (he is gaining, but not fast enough). They have us supplementing 2 ounces after a few feedings a day. (He does not like the formula, so that's been tough.) I'm at a loss. Any suggestions?

You are certainly a trooper to continue breastfeeding through all of these problems. Wow! I know you are wondering when this will get better. I hope that it will be better very soon.

Do you feel his latch is right? A good latch does not cause pain – even with sore nipples it usually hurts only in the beginning. Are you making sure his head is slightly tipped back and that you start your nipple at his nose and slide it down into his mouth, making sure his bottom lip is flanged down and that he has as much breast tissue in his mouth as he can?

He is at a very distractible age, so you may need to remove him from distractions when he is nursing so that he won't decide to watch the cat go by while feeding or turn to listen to every voice in the room – including the TV.

If you are quite sure the latch is not the problem and the physician is quite sure it is not yeast, then you might want to ask one more time if it would be OK to try another course of gentian violet for you and the baby, just in case it is yeast anyhow – or a course of oral medication, Diflucan. Sometimes yeast does not show up in the baby at all.

If you don't respond to these, you might want to see a dermatologist who can see if you are having some type of eczema or dermatitis on your nipples that is causing such pain. Also, if you are going to breastfeed him after he has had formula, give him a few sips of water before nursing in case you are having a reaction to formula on your nipples.

It is never easy to write to moms with sore nipples without being able to assess the baby at the breast and to see the breast for myself. You have been through so much, and I hope one of these will do the trick for you. If you haven't attended LLL meetings, you might want to go and have the leader observe your baby nursing, and also observe other moms nursing to see if you can pick up any tips.

I wish you well and hope that very soon things will be better for you."

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