What is going on?

[PickledLily]

My 5wo is EBF. One breast works fine, the other is proving problematic but I've not a clue why, despite lots of reading and advice.

The 'bad' side:

• engorged after a few hours (the other side is fine)
• fast let down
• recurring blocked ducts (including one massive one - not painful but keeps disappearing after a feed, only to reappear again once engorged)
• LO only has a shallow latch and tries to suck on just the nipple (ouch). I have to pull her chin/lip down
• nipple is flattened with blanched stripe after feeding
• nipple is now pink and sore/stinging, like let-down, but all the time (thrush, or just over-used? LO suckles for hours given a chance)

Latch is better on the other side (no misshapen nipple) and has been assessed by BF advisor and HV.

Add to that, LO screams/cries and thrashes around during/after feed (upto 90mins), similar to someone else posted on here. GP thinks it could be reflux and suggested removing milk from my diet as a starting point prior to trying drugs.

But not sure that explains the lack of latch. Could it be some form of tongue-tie, on one side only?

Feel like I'm going in circles but not resolving the underlying problem. And the continuous crying/fussing/suckle cycle is making it difficult to get out and about.

What's the problem, or do I need to just let her grow out of it?

Sorry, am a bit glum about it all at the moment. :(

have you tried a rugby ball hold on that side, so she is in the same position as when she feeds from the "good" side?

Yes, she seems to latch on better in the rugby hold, but I really struggle to hold her in that position.

The other thing I've noticed is that even when I try to get her head/body aligned, she often seems to have her head turned slightly from her body.

She seems to be having latch problems on that side which is meaning that she can't remove milk properly hence the blocked ducts and engorgement.

My SIL had similar issues and what sorted it out was some cranial osteopathy as it turned out her DS had some problems with his jaw on that side resulting from his birth. Obviously, this may be completely different for you, but it may be worth considering what sort of birth you had and if there may be any thing that could impact on the feeding.

Pink, shiny nipples can indicate thrush and the pain lasts after a feed too. Usually in both breasts (although lots of mnetters will disagree with me there) as it's so contagious.

I've never heard of tt affecting one side only tbh.

Could it be the fast let down is making your baby a bit uncomfortable on that side? A shallow latch could be a coping mechanism for a fast flow? I struggled with a fast let down and found that feeding lying down or leaning back helped quite a bit. The latch could also explain the sore nipple and if all ducts are not being drained, could explain that too. If baby is swallowing a lot of air (can also happen with a fast let down) that could explain her discomfort afterwards.

Re excluding milk from your diet I would try better latch and positioning first, and then maybe look at infacol or other things to help with reflux. Seems a bit odd to me to suggest something so drastic at first, when cows milk allergy through breastmilk is really very rare.

Has she been checked for tongue tie properly? It can cause one-sided pain and 'lipstick' shaped nipples and blanching. It's often missed, so try to find a lactation consultant or BF Counsellor who is experienced enough to spot even a slight tie. HV's are generally not qualified to identify tongue tie.

As regards fast let-down, have you tried laid-back nursing? Either Biological Nursing or feeding lying down? The former means the milk is flowing 'up hill', the latter means the baby can dribble out what they don't want, rather than get overwhelmed. You could also try letting baby suckle until let down starts, then fire off the fast flow into a muslin or towel, then latch baby back on when the flow has calmed down a bit.

Babies fuss and cry. I wouldn't necessarily rule out reflux or lactose intolerance, (NB. They're different, you removing diary wouldn't necessarily make a difference if LO has reflux) but babies have an immature gut, so they fart, they burp, they writhe and wriggle. It can be distressing for us to watch but isn't always indicative of a problem.

Try keeping LO mostly upright after a feed for 20-30 mins, either on your chest or propped on a cushion, in bouncer etc. Put some books or blocks under one end of the cot/basket. If co-sleeping, keep LO's head on your upper arm, again so their head is raised. If it IS reflux those are minor adjustments that can make a difference, as gravity is your friend!

If you're finding it hard to get out and about, try getting out and about to a BF group/cafe somewhere. That way you'll most likely meet someone in the same boat and won't feel so anxious, and will probably get some good advice at the same time. It definitely sounds like someone needs to watch a feed from start to finish to assess what's going on.

I'm no expert, so I'm sure others will come along to offer something more concrete soon.

Some babies 'clamp down' on the nipple if the flow is too fast (rather like treading on a hose pipe!), over-active let down can just affect one side (or be more manageable for the baby on one side), this can leave a 'stripe' on the nipple.

A tongue tie may affect one side as TT can cause tensions with in the neck/jaw which may be more apparent on one side and not the other depending on how the TT has developed. A proper assessment would have to be done (this would involve things like a suck assessment, perhaps a physical exam where the underneath of the tongue is felt - rather than a quick peek and a 'That looks fine to me, see he can stick his tongue out' )

If there is still issues with the latch (as evidenced by the blanched/striped nipple) then thrush medication can only really be prescribed when the latch is comfortable and the issues resolved, otherwise you and the baby may be exposed to drugs that weren't needed (some bfing problems can have effects that mimic some thrush symptoms so until the issues aren't an issue thrush can be reliably diagnosed).

Have you tried the bfing helplines or seen a BFing counsellor or an IBCLC? A feed would need to observed from latch on to the baby finishing the feed (pref. observed on both sides if poss or if not just the affected side) so that all eventualities/possibilities can be considered.

oh my god, Lily - i have those same problems!

i have to admit i gave up trying to solve her shallow latch
she's right about half the time and my nipples aren't sore when she's not latched badly iyswim.

the blocked ducts, i have found that if i let her feed and feed and feed from that side, it solves it (usually through the night) and if it doesn't i just express putting pressure on the sore area (ow)

i'm not offering advice though because i'm crap at solving this one.
just letting you know you're not alone.

Thanks for all the replies! It's not straight forward is it? Honestly, babies should come with a manual on how to 'operate' them.

Feeding/sleeping upright has helped the reflux symptoms; feeding lying down (and expressing the first 'jet' of milk) has helped with the fast let down, whilst Infacol has helped reduce the explosiveness of the wind.

I think the GP mentioned cows milk intolerance (not allergy) as it's apparently quite common. Seems straight-forward enough to cut out cows/soya milk for a couple of weeks.

The BF adviser is going to check up on the latch again, so I'll see what she says. Then I'll consider the cranial osteopathy (have heard good things about one locally).

I realise that much of this is probably just a developmental phase (although I seem to be the only one out of everyone at my BF groups that has this issue; it would be nice to make it less painful for both of us.

And if nothing works, I'll be getting the gin out

Great link to biological nursing Mombojombo - I was lucky as my HV showed me this on my Day 5 visit and it transformed feeding so perhaps worth a try Lily amd Nickel?

I had the same issue on my left side and, as have had it with both my babies, presumed it was my 'equipment' so to speak. Whilst the biological nursing helped so much, it didn't remove this problem but just to reassure, if you don't find an instant solution (and i really hope you do), after a few weeks it all settles down. I sometimes still get the flattened nipple etc but there is no pain and bf is fun again!

Sounds like you've got lots of great advice though Lily, and a good plan in place so I hope something clicks for you both