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Infant feeding

Get advice and support with infant feeding from other users here.

Nipple is getting pinched - what am I doing wrong?

24 replies

Daffodilly · 20/02/2009 19:29

DS is 4 weeks old and feeding has been going OK overall. Latch is initally painful and then generally improves once he gets going. However, when he comes off my nipple looks "pinched" and shaped like a lipstick tip. One side is worse then the other and ends up very white and almost little blisters along the pinched edge. That side is now getting increasingly painful both during and between feeds.

I know this isn't right, but not sure what I am doing wrong. He doesn't open his mouth very wide. Have tried holding his chin down once latched on which helps a bit.

Any other suggestions (have tried BF support lines but can't get through so thought I'd see if anyone here had ideas)?

Thanks

OP posts:
hodgepodge · 20/02/2009 19:36

Hi - I'm really not an expert at all - have one baby three months old, but we went through something similar when he was 8 weeks and it turns out he was tongue-tie - which means he couldn't latch on and breast-feeding had become incredibly painful. Have you ever seen him stick his tongue out?

Also is it both boobs? The other things I was told could be causing it are infection (likely to only be one boob and only hurt in one place) - or thrush (both boobs and will mean baby finds it uncomfortable feeding if he has it in his mouth also - which they very often do)

if it's infection you need antibiotics - but they make thrush worse - so I'd suggest trying thrush treatment on both of you as a starting point - you can buy Daktarin oral gel and cream from the chemist - you should notice a difference within 3 days

good luck!

hodgepodge · 20/02/2009 19:43

and let me know if you need any more info

Daffodilly · 20/02/2009 19:45

Don't think it is thrush (had that with DD and it was AWFUL) or infection. Think he is chewing on the nipple. I haven't seen him stick his tongue out now you mention it, how would I check for tongue-tie? I've heard of it but don't know much about it.

OP posts:
plonker · 20/02/2009 19:47

I'm going to second what hodgepodge said - I had this prob and my dd was tongue-tied too.

Ask HV to check for you, or even better, can you get yourself along to a breastfeeding clinic?

plonker · 20/02/2009 19:56

Take a look, is the tongue 'free' or is the frenulum (skin attaching tongue to bottom of mouth) secured to the bottom of ds's mouth?

Can/does he poke his tongue out?

My dd's was very obvious and you could see it very clearly when she cried, her tongue was almost stuck to the bottom of her mouth. Also, what is the tip of his tongue like? My dd's was in a little heart shape where the tip strained against the frenulum.

hodgepodge · 20/02/2009 20:25

If you can look under his tongue (easiest when he is screaming!) you will see a little bit of ligament joining the tongue to the base of the mouth - it can come all the way to the tip - but not necessarily (mine didn't) - pop it in Google Images and you'll see what it can look like.

Daffodilly · 20/02/2009 20:35

Thank you for clear directions - he is fast asleep at the moment (so cute), but due a feed anytime, so I will wait til he is screaming for it and check out the tongue!

OP posts:
Qally · 20/02/2009 21:01

The lipstick thing is classic tongue-tie - and it hurts like mad, so you're braver than I am! TT babies often have unusually small mouths as well, and shorter tongues, so that can be a problem in terms of getting a decent gape (that improves with age, thankfully). If you put your finger in his mouth to break the latch, is his tongue the first thing you encounter? My son couldn't bring it forward at all, so he clamped his teeth just behind the nipple, and chewed with his gums, while sucking the nipple up to the hard palate. When I put my finger in there was never any suction and I used to have to try to pry his gums apart - it was tricky, and I'd wonder wtf everyone meant, telling me to break the suction! Sound similar at all?

If it is a tt, some Trusts are out of date and try to avoid cutting (mine is one). This is not in accordance with NICE guidelines, if it's causing problems with breastfeeding, and if nobody locally is qualified to divide they should provide an NHS referral to someone who is. I was referred to Southampton, which is the leading centre of excellence in the UK (and internationally actually). We paid a cheque in case our Trust got sticky, as we were able to get a next-day appointment that way, but our Trust actually paid up without quibbles and the cheque was posted back to us uncashed. Even if we'd had to pay, it would only have been £90 - my Mum said it was a snip, which has to be the worst pun I've heard in a while, but accurate!

hodgepodge · 21/02/2009 07:31

There is also an excellent tongue tie clinic at King's College Hospital in London - where we went - they are very keen to do the snip if you having trouble breastfeeding - but Qally is right, lots of GPs/midwives/hospitals won't do it unless it interferes with speech (fat lot of good when you have a 4 week old!!)

If it is then get it done asap I'd say - I'm still having problems with feeding as ds wasn't spotted til after 8 weeks - in the meantime maybe express some feeds just to give the nipples a break - or nipple shields? I bought some but haven't tried them - might be worth a go though...

Daffodilly · 21/02/2009 09:20

Thanks for that Qually. I did some poking around in his mouth last night and I'm not sure about tongue tie (not that I'm an expert). He can stick his tongue over his gums, though haven't managed to get him to poke it all the way out yet. If I put my finger in to break his latch I do feel his tongue over his bottom gum (though not very far over). Also the problem is mainly on one side - wouldn't a problem with his mouth affect both sides?

Think I might try nipples shields for a day or two on the hurting side and see if it settles down. If not I guess I need to get to a BF clinic and have someone observe me feeding.

Thanks for all the ideas. Good to know that there is a clinic in London if we need it too.

OP posts:
Marthasmama · 21/02/2009 09:24

Is your let down fast? Sometimes they bend your nipple over to stop themselves from choking on the flow. My DD did this when she was a few weeks old and I could feel her do it, ouch!

Marthasmama · 21/02/2009 09:25

Just noitced that you also said it is white on one side. Again, this happened to me with the bending. here is some info if you think it could be your let down.

Daffodilly · 21/02/2009 12:11

I think I do have a fast let down - he sometimes chokes on it a bit and if he pulls off it can spray out! Mind you I still don't understand why it only a problem on one breast.

I did his last feed with a nipple shield on that side and after the first minute or two it felt OK. Feels a bit better after the feed too.

Reading up on Kellymom I think shallow latch could be the problem. He doesn't open his mouth very wide.

Hoping the nipple shield will let nipple recover.

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MamacitaGordita · 21/02/2009 12:50

Daffodilly I remember this lipstick shape too (OW) and my DS is not tongue-tied. For me it really was just a latch problem and not opening wide enough- I found waiting just a second longer for a slightly wider gape helped, and tickling his top lip to get him to open and then dragging my nipple down his lower lip to encourage it to curl out IYSWIM. Tough to describe in writing! In the end I think his mouth just getting bigger helped as well... sorry I can't be more helpful.

Marthasmama · 21/02/2009 14:30

Have you tried the football hold position? My DD wouldn't open her mouth when she was a few weeks and I had really sore nips. My lovely MW suggested trying the football hold and it worked a treat. Now she's fours months and we have no problems (touch wood), so things do improve. Hang on in there and it will get better.

Marthasmama · 21/02/2009 14:31

Heh, I mean four not fours

Daffodilly · 23/02/2009 18:33

I've been using the nipple shield for last couple of days and it has helped, but as soon as I stop the problem is back.

I also looked at pictures of tongue tie on Google and investigated his mouth more. I now think he may have a bit of tongue tie - when he sticks his tongue out (which he can do a bit) it looks very slightly "W" shaped at the end. How would I go about getting a proper diagnosis? Would they even do anything as I don't think it is very severe (not like some of the pictures) but is making me very sore?

OP posts:
Qally · 23/02/2009 19:39

It's possible to have a tie through the centre of the tongue, but not underneath. My son is in this position, although he also had a 100% tie underneath that had to be cut twice (thin tie that turned thick at the end - the first actation consultant we saw missed the thick part at 3 days and it was cut a second time, by a paediatric consultant, at 5 weeks, and the tongue's own restriction was diagnosed at 12 weeks at the specialist bf clinic at the John Radcliffe in Oxford. One of the advisors there had had a friend, who'd co-authored her book on the latch, with the same problem).

It looks like the top of a heart, upside down. Apparently it means you have a 1% margin of error in latch technique, when most people have about 10%. I also have very big boobs when milk-producing, 34H, which can cause further problems in this situation as the sheer weight pulls the nipple from the mouth, and the baby is already having trouble milking the ducts efficiently - they use tubigrip slings at the clinic sometimes to add a bit of extra support.

I recommend seeing your GP as a starting point, as some are great. If yours isn't, contact Mervyn Griffiths' secretary at Southampton General - he is wonderful, and if your GP makes a referral he will squeeze you in asap. He is the leading international expert in tongue-tie so really we're lucky to have him in the country, and he is also lovely. When he met us, the first thing he did was greet my son, shaking his hand and saying hello.

Alternatively the bf clinic at the JR in Oxford are absolute experts, too. If you aren't even remotely local, either will be able to recommend someone who is, I imagine.

I'm going to start trying bf again this week, I had to stop as the frustration and misery of constant misdiagnosis and partial diagnosis and bad advice and pain meant I had nothing left in the tank by the time the real problem was established. There's only so long you can take pain on this scale, even without the rest of the hassle. Personally I have found expressing a lifesaver - he's still getting bm, and I have a great supply, so I can now go back to trying to sort bf with renewed vigour. If your baby is causing you a lot of irresolvable pain, for a complex physical reason, then it can be a godsend.

I would avoid seeing a lactation consultant. Non-obvious tongue-ties need very specialist treatment, and both the board certified lactation consultants I saw set us back a very great deal - weeks, in both cases. I'm sure a lc is fantastic for the more ordinary bf problem, but when enduring very painful feeding, and a very hungry baby because the milk transfer is totally inefficient, misdiagnosis and inappropriate advice is the last thing you need.

Daffodilly · 23/02/2009 20:49

Thanks so much for all the info Qually. I will try starting with my GP. I don't want to make a huge fuss, I could be totally wrong about it being tongue tie - I don't have lots of babies tongues to compare to!

Lots of luck with restarting BFing. It is so great when it works, and yet can be such an uphill struggle. Credit to you for not giving in.

OP posts:
Daffodilly · 25/02/2009 21:24

Just to update all those that replied. I saw a BF counsellor todat who confirmed that DS has mild tongue tie. She reckoned that this is stopping him opening his mouth wide enough to feed properly. He seems fine - gaining weight and healthy, but painful for me.

She's referred me to get it looked at by oral consultant next week. However, she says even if thay agree to snip it, it won't instantly solve problem as he has learnt a "poor" latch and needs to re-learn to open wide.

So any advice on how I achieve this - and how to survive next week (6 x approx 7 feeds per day) with one nipple in tatters and the other heading that way?

OP posts:
zeeka · 06/03/2009 23:55

Cover nipple in lansinoh lanolin before and after every feed. Take ibuprofen and paracetamol too. I had very damaged nipples due to poor latch and remember the agony Poor you!! I really feel for you. After seeing a bf counsellor I managed to improve my twins' latch and after a few weeks the nipples healed and had no cuts (hallelujah!). Feeding was then an entirely different experience, and was wonderful to not dread every feed!

Hope you are getting on OK... good luck. You are really doing very, very well to keep going xxx

Daffodilly · 07/03/2009 11:12

Thank you so much zeeka for that. It is very up and down still but I so want to persevere...

OP posts:
lipblush · 02/04/2009 15:50

Hi Daffodilly,

I had the same exact problem. That lipstick tip is a clear sign that your LO has tongue-tie. I didn't know that either until at the hospital before we left I complained of how my nipples were sore. The lactation consultants looked at my nipples and then showed me a video about tongue tie - and the video showed the 'lipstick effect' and also how they can crack and bleed. My DD also leaves blisters on my nipple as well. She also doesn't open her mouth very wide, but mainly bc she has a small mouth (which apparently is common for children with TT). I have quit BF bc I couldn't really get any help. She had her frenulum cut before we left the hospital (she was born on Christmas) but that didn't help. I have seen 3 lactation consultants and the last one told me to quit bf if I wanted to save my nipples. My boobs were so sore that I couldn't even cuddle or hold my baby after feeding her. Msg me if you have any more other questions. I could go on forever....!

lipblush · 03/04/2009 00:01

Hi Daffodilly,

I had the same exact problem. That lipstick tip is a clear sign that your LO has tongue-tie. I didn't know that either until at the hospital before we left I complained of how my nipples were sore. The lactation consultants looked at my nipples and then showed me a video about tongue tie - and the video showed the 'lipstick effect' and also how they can crack and bleed. My DD also leaves blisters on my nipple as well. She also doesn't open her mouth very wide, but mainly bc she has a small mouth (which apparently is common for children with TT). I have quit BF bc I couldn't really get any help. She had her frenulum cut before we left the hospital (she was born on Christmas) but that didn't help. I have seen 3 lactation consultants and the last one told me to quit bf if I wanted to save my nipples. My boobs were so sore that I couldn't even cuddle or hold my baby after feeding her. Msg me if you have any more other questions. I could go on forever....!

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