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Pale areas on nipples after feeding...

(25 Posts)
drcharliegirl Sat 22-Jun-13 13:40:16

Hi all,
May I solicit some crowd wisdom?

My DD is now 3 weeks. We struggled initially with the breastfeeding but by week 2 I really felt like we had the hang of it... Latch checked by 3 x MW and HV.

Just in the last few days it has become really sore. Latch has always had a wince factor, but then it would settle down. Now I get a burning pain that increases as the feed goes on. No matter which side, no matter which hold.

After about 30s after finishing feeding, my nipple becomes very pale and feels like there are hot needles being stuck into it. There are no cracks to see, and with warming the blood flow returns, but it can come and go for many minutes...

Anyone have any experience of this? I gather possibilities are vasospasm and candida (babe has no symptoms).

Help! I'm already dreading each feed and I think babe is picking up on my reluctance...


BoysAreLikeDogs Sat 22-Jun-13 13:43:51

I would be thinking vasospasm too.

Can you access RL help? LLL, bf counsellor.

Pleasenomorepeppa Sat 22-Jun-13 13:46:10

I had thrush & that's what it felt like.
How is LO's tongue & mouth?

drcharliegirl Sat 22-Jun-13 19:56:52

No symptoms in LO at all. And definitely no tongue tie (I'm a paediatrician).

I have self prescribed some antifungals just in case, but I think vasospasm more likely too...

Boysarelikedogs, sorry - help me out - what or who is RL?


bonzo77 Sat 22-Jun-13 20:00:50

RL= real life.

Helspopje Sat 22-Jun-13 20:03:07

i'm a paed too
I had this and it took 6 weeks and 2 visits to BF support to diagnose posterior tongue tie. he was literaly sucking the life out of my nipple and the pain on rewarming was awful.
frenulum and tongue look normal.

drcharliegirl Sat 22-Jun-13 20:28:07

Interesting - if frenulum and tongue look normal, how is this diagnosed?
And if they look normal, there is nothing to divide, and presumably I just have to wait for it to get better?

drcharliegirl Sat 22-Jun-13 20:29:45

Thanks bonzo - I have been to MW and HV and have telephone support from lactation consultant but perhaps I need to actually SEE someone (easier said than done!)

mawbroon Sat 22-Jun-13 22:49:31

Frenulum and tongue may look normal to the untrained eye but someone who specialises in this area will look at the shape and lift of the tongue when the baby is crying as well as running a finger under the tongue to feel for a "speed bump" and taking into account the breastfeeding history. If the baby has a high palate, there is probably also a tongue tie. The lip should be checked for a tie too, but not many are doing this yet in this country.

FWIW, the paed surgeon who ran the tongue tie clinic told me that ds1 had no tie. He did not know how to diagnose a posterior tie and ds1's tie was quite significant although his tongue looked "normal" it was the back of the tongue that was tied down restricting the movement.

I had blanched nipples when he was feeding as a baby, often with a crease down one side or shaped like a new lipstick.

this is a good starting point

And there is a tongue tie babies support group on FB where you can post pics, obviously nobody can diagnose, but you can ask opinions from people who have been there.

mawbroon Sat 22-Jun-13 22:53:37

Sorry, also about you saying there is nothing to divide if it looks normal - the tie can be submucousal. DS1 had his lasered (he was 6yo by this time, so a different experience to a baby) and the dentist had to go in quite deep to release the entire frenulum.

Please do get her checked out because undiagnosed ties can cause many problems. DS1 is 7yo and has had multiple problems over the years stemming from his high palate and tongue/lip ties.

drcharliegirl Sat 22-Jun-13 23:28:44

Thanks for this - will get it checked definitely. Though I wonder if there is any advice for what to do while I am
(Hypothetically) waiting for laser treatment on the NHS???!

mawbroon Sat 22-Jun-13 23:46:43

Not so sure that there is any laser treatment available on the NHS.

Where are you based? There are dentists in Huddersfield and North London who have trained with Dr Kotlow and would be able to give you a diagnosis if applicable. They both use laser.

In the meantime, trying an exaggerated latch or flipple might help, also have a look at biological nurturing.

drcharliegirl Sun 23-Jun-13 00:28:18

That's great- thanks! Never have managed to get the hang of biological nurturing... Can't see well enough to get any kind of latch over the H cups...!
Will definitely try the flipple technique for the next few feeds and see if things improve at all.

I'm in London - will head to BF cons Monday and see what they say. Thanks again for the help...

McBaby Sun 23-Jun-13 10:38:05

There are good nhs tongue tie clinics at royal free and kings. The ent surgeon at royal free also does it privately if you can't wait the 3-4 weeks for referral.

I had very white nipples after feeding due to extreme compression from my LO due to posterior tongue tie. Again this was missed on a number of occasions.

Helspopje Sun 23-Jun-13 16:33:21

where in london - we are south and the whole referral process took 10d from being seen initially - went to BF cafe last week and the wweek before and being seen for division at kings on Monday. Don't think it is laser, but apparently posterior ties can be dealt with by conventional techniques too.

In retrospect, the big giveaway for my son is that he can only get the tip of his tongue level with his lips - they're supposed to be able to get it out way beyond.

Feel free to PM

drcharliegirl Mon 24-Jun-13 11:19:14

We're in west London. I have an appointment with the infant feeding consultant at the hospital this pm so hopefully will get some answers (though she did tell me by phone that she would have to google vasospasm and that there was probably nothing that could be done about that... Worrying!)
Thanks for the help all...

I may yet be seeking a private lactation consultant opinion!!!

drcharliegirl Mon 24-Jun-13 11:20:04

PS I managed the flipple twice and thought it had changed everything - but now it's not working again.
So frustrating...

mawbroon Mon 24-Jun-13 14:17:51

An infant feeding consultant who had never heard of vasospasm? Hmm. Not sure I would be putting much faith in their advice tbh.

If going private for a consulation about possible tongue tie is an option, then it would be worth contacting Malcolm Levinkind. He is a dentist in North London and he trained with Dr Kotlow.

drcharliegirl Mon 24-Jun-13 19:06:40

Ok, so the verdict is definitely no tongue tie. Neither posterior nor anterior with normal excursion of the tongue out of the mouth beyond the lower lip.

So thanks for all the help, now looking for solutions to the vasospasm issue - has anyone tried nifedipine?

Helspopje Mon 24-Jun-13 23:55:51

LD LA Nifedipine seems to be the drug of choice but duff latch stastistically way more likely

mawbroon Tue 25-Jun-13 11:16:44

Agree with Helspopje.

Also, worth bearing this thread in mind.

Being able to stick the tongue out does not eliminate the possibility of tongue tie.

mawbroon Tue 25-Jun-13 11:18:09

Also, did they do this when checking?

Helspopje Tue 25-Jun-13 13:26:20

we had snip yday - instant relief!
now just irritated that all the people that I told that I was concerned re. TT (incl new baby check on d1 of life) dismissed me out of hand
7 weeks of unnecessary pain and 7 weeks of bad feeding behaviour to unlearn

mawbroon Tue 25-Jun-13 20:33:52

Were you told to do stretches and massage to avoid reattachment Helspopje?

Dr Kotlow has instructions for aftercare on his website, but the computer totally froze and I can't link to it!

Helspopje Wed 26-Jun-13 09:59:35

tod about massage from d4 but keen o see the link if you find it
finding the advised 2hly feeds wearing though...

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