THRUSH

Mary:
Help! I think I have thrush - what can I do ... I'm confused by all the remedies out there!

Kenyatta:
The most common medication for this is called Nystatin and is actually VERY similar to what your dr. gave you. I too was concerned about the chemical content of the cream, but the pharmacist and both my ped and OB told me it was safe to use.

I tried the Genetian Violet too (in addition to the Nystatin) and had to have my pharmacist order it... it is OTC (over the counter) here in the U.S. but is not something they usually carry in stock.

There are two things you can do now. The first will help to avoid aggravating your thrush (yeast infection) is to make sure and NOT lubrucate your nipples with your breastmilk... the yeast will thrive and grow on the sugar in your milk. You may just want to use a washcloth to pat them dry after Elizabeth nurses.

The second thing you can do is to eat yogurt (if neither of you has any milk allergies) or purchase some Acidophilus from your health food store.... Acidophilus is a wonderful natural yeast killer!

I noticed many women can not find Gentian Violet in their areas. My advice would be, if you order online, to speak with your doctor AND pharmacist before applying treatment.

SORE NIPPLE DUE TO TEETHING

My daughter has started teething and has decided to start biting me! Now my nipples are sore every time she eats. They only stay sore for a day or two but everytime she nurses, they hurt! What can I do to ease the pain?

Kenyatta:
Hi Carol!
I definitely remember that. Christian had his first two bottom teeth by the time he was 3.5 months and he chomped on me a couple of times as well.

What helps to remember is that, when they are TRULY hungry, you will NOT feel their teeth. If she's biting you, she isn't as hungry as she is either playing or using you as a teether...

Are you giving her anything to alleviate the teething? I used Hyland teething tablets ...or I would let him chew on a frozen waffle.

But when he was REALLY ready to eat/nurse, I would never feel those two sharp little teeth.

Paula:
Carol, I too had an early teether - 4 teeth at 3 months, 8 at 6 months, so I've been nipped a few times too. If Katie is really eating and latched properly she can't bit you, her tongue is over her teeth. If she continues to nip or clamp down, remove her from you breast and tell her something firmly, I used "NO BITE" - G3 quickly got the picture and my physical reaction of having to be peeled from the ceiling convinced him to stop. In the mean time, you may want to apply some Lasinoh ointment to promote healing. You may also be experiencing heightened sensitivity due to your pregnancy? The other thing I noticed with Gary was that his top teeth would rake along my areola causing it to get a bit raw. Sadly only time and wear will help you to adjust to that.

Good luck! Try not to pull the carpet out with your toes!

Tammy:
Because I want to be successful at breast feeding, I want to have on hand what I may need should I experience tenderness, cracked/sore nipples, etc. Are there any must haves you all would recommend? What brand of Lanolin have provided you with the most relief. I'm due in 6 weeks.

Kenyatta :
Hello! Lansinoh worked the best for me. I wish I would have known about it BEFORE I went in for my c section ... because I could have used it! The good thing about it, is that it works FAST!!! and a little goes a long way...just look for the purple tube ....

Alissakae:
Lansinoh is great because it is highly purified and doesn't have to be washed off of your nipples, and it doesn't cause problems even for people who are sensitive to wool.

Paula:
Lansinoh kicks bootie! I also used pure lanolin before finding Lansinoh. The Lansinoh is easier on your likely sore nipples and promotes healing. I liken it to Neosporin for a cut. Another thing to remember is that Lansinoh is NOT a problem is baby ingests it (at least according to everything I've read. I include a tube in shower gifts of moms that I know are planning to BF - it makes a great gift, especially when many new moms don't know about it until its almost too late.

Lorna:
I was skeptical at first, likening it to those cremes that 'prevent' stretchmarks. But then I used it on my blistered nipple and it had cleared up within three days. The lactation consultant told me it could take a few weeks . Long live Lansinoh!

Tammy:
Wanted you all to know I greatly appreciate your input and have since purchased a few tubes and have started to use it twice a day as the instructions suggest (in an effort to promote healthy skin prior to breastfeeding). I also have a problem with very dry heals (they will crack and bleed and can be very painful). I applied this product and it kicks butt. I'm glad to have tried it. Thanks.

SORE/PEELING NIPPLES

I am currently 6 months pregnant and my nipples are already peeling! It looks like I've sunbathed in the nude or something (a scary thought in itself). I've avoided soap for quite a while, but they keep right on peeling. I hear about this happening after you start bf'ing, but isn't this a little early? Should I maybe try Lansinoh now? I'd appreciate any suggestions!

Nathanx97:
Hey! What timing. I just noticed this last night. I'm 25 weeks pg and my nipples have some sort of old skin on them. I tried to remove it, but it made them very "raw", but they didn't bleed. I'm just leaving it. What's the peeling about?

Paula:
I think peeling them sounds terrible and I can't believe it would be a good idea. Just like peeling a sun burn or any other type of skin. It will come off in time with normal clothing abrasion. I'd give the Lansinoh a shot, it certainly can't hurt. I'm betting it will solve itself in time. If you get really worried, check with your OB.

OVERACTIVE LETDOWN

When I'm nursing my 2 week old little boy, my let down seems to drown him. He can't seem to keep up with the flow, I have to take him off and stem it and put him back on. I had the similar problem with my first born, but it didn't seem to get to this degree. It seems my milk is really flowing this time. I don't want my little one to suffer from this, but I don't know what to do. Does anyone have any tips for me? He eats only for a few minutes and then when the let down comes, he quits. When he's awake it seem like that's all I'm doing is putting him to the breast and taking him off again. Thanks for any help in advance.

Kenyatta:
Hi Denise!

It sounds to me like something my OB described as overactive letdown. While I didn't have this problem, like I thought at the time, this is what the pamphlet that she gave me from La Leche says:

You can try different positions so baby can be "uphill" from her breast. For example, mother can lie on her back with baby on top so he can control his head and back off if the milk ejects too forcefully. Another suggestion might be to take baby off the breast when the let-down starts, catching the overflow in a clean cloth, and placing the baby back on when the flow lessens.

NIPPLE CONFUSION

Kenyatta:
When I was pregnant, I was scared, confused by all the information out there, and began keeping a little notebook about various things, including all I could on breastfeeding.

I managed to meet a very nice person, who became a "mentor" of sorts, and she not only gave me tremendous support during a scary pregnancy, but a lot of helpful information about various issues concerning breastfeeding, which she knew I really wanted to do.

If you all don't mind, I'd like to post some of the information about nipple confusion which she passed on to me, and which I found extremely informative.

What is Nipple Confusion?
It is a problem that arises when a breastfed baby is given an artificial (rubber or silicon) nipple and must try to learn to nurse both from his mother's breast and the bottle nipple. While seemingly similar, these two feeding methods require COMPLETELY different mouth and tongue motions and swallowing skills.

In breastfeeding the baby needs to take as much of the nipple and areola into his mouth as possible to 'pump' the milk from the milk ducts. In bottlefeeding he uses his lips to grip the tip of an artificial nipple. Some nipples do better imitate a natural breast, but none are quiet the same.

In breastfeeding the baby must place his tongue BENEATH the nipple and uses it to help create the 'vacuum' needed for nursing and to pump and swallow the milk. In bottlefeeding the baby must place his tongue in front of the nipple and uses it to stop the flow of milk while he swallows.

In breastfeeding the baby removes milk from the breast by a combination of sucking and pumping the milk from the milk ducts. When the baby stops sucking & pumping the milk stops flowing. In bottlefeeding the milk flows fairly readily from the nipple once an initial suction is created and then the baby simply controls the flow by placing his tongue over the holes in the nipple.

This is not to say that either feeding method is 'wrong' ... only that they are VERY different and that a baby must learn whichever method he is to use ... and expecitng a tiny baby to learn both methods and to be able to switch back and forth between the two can be extremely frustrating to both baby and mom.

In Dr. Jack Newman's article More & More Breastfeeding Myths he discusses nipple confusion as NOT being a "myth": (text from his articles is in italics)

9. There is no such thing as nipple confusion.

Not true! A baby who is only bottle fed for the first two weeks of life, for example, will usually refuse to take the breast, even if the mother has an abundant supply. A baby who has had only the breast for 3 or 4 months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

In his article Breastfeeding?Starting Out Right he goes on to say ...

3. Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever method gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, he will tend to prefer the rapid flow method. You don?t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don?t seem to be able to manage it. Nipple confusion includes not just the baby refusing the breast, but also the baby not taking the breast as well as he could and thus not getting milk well and /or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see handout #5 Using a Lactation Aid, and handout #8 Finger Feeding) why use an artificial nipple?

In his article How to Know a Health Professional is not Supportive of Breastfeeding he goes on to say ...

5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to your baby to make sure that the baby accepts a bottle nipple. Why do you have to start giving bottles early if there is no such thing as nipple confusion? Arguing that there is no evidence for the existence of nipple confusion is putting the cart before the horse. It is the artificial nipple, which no mammal until man had ever used, and even man, not commonly before the end of the nineteenth century, which needs to be shown to be harmless. But the artificial nipple has not been proved harmless to breastfeeding. The health professional who assumes the artificial nipple is harmless is looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of infant feeding. By the way, just because not all or perhaps even not most babies who get artificial nipples have trouble with breastfeeding, it does not follow that the early use of these things cannot cause problems for some babies. It is often a combination of factors, one of which could be the using of an artificial nipple, which add up to trouble.

But what if your baby has already been given bottles? Perhaps in the hospital against your best wishes ... or perhaps because of a condition which prevented the baby from nursing for a while? Is all hope lost? Absolutely Not!

Babies CAN learn to breastfeed after being bottlefed, and babies can even learn to do both. Some suggestion are ...

• If at all possible delay introducing the bottle until the baby has WELL established nursing and latch on skills.
• If baby must receive suppliments early on, use a Supplimental Nursing System, feeding cup, medicine dropper or spoon to feed baby.
• Avoid the use of pacifiers which only further enforce the "tongue in front" nursing
• Pump or hand express a bit of milk before attempting to latch baby on so that your milk is READILY available, as it is with a bottle, and baby doesn't become frustrated waiting for let down.
• Attempt to nurse frequently, but be prepared to offer expressed milk or formula if your baby is not able to nurse efficiently.
• Be sure baby is latching on properly - taking the entire nipple and as much areola into his mouth as possible. DO NOT allow baby to suck on just the tip of your nipple ... he will not get milk, and you will end up with sore nipples. If baby is latched on imporperly, use your finger to gently break his suction and try again.
• Seek 'in-person' help from a local lactation consultant or LaLeche League leader if one is available. But be sure to find a support person that you feel comfortable with ... working with someone who makes you tense or upset will only make matters worse.
• And finally ... Be patient with yourself and your baby. It is common to have difficulties with nursing ... and it doesn't mean you or your baby are a failure ... it simply means that it will take extra effort and patience to make things work for you.

Nathanx97:
Make SURE in the hospital they know you are breastfeeding AND that they don't give bottles of ANYthing, including pacifiers. They gave my son BOTH fo these, WITHOUT informing me. He had terrible nipple confusion, and would SCREAM every time he tried to latch onto me, out of frustration. Coincidence? I think not!

See if your OB, Ped's office, or your HOSPITAL has a free lactation consultant. Sure, you can pay someone, which is fine, but the one who helped us the most was the free one, not the one we paid!

PROBLAM NUM-1 (BLISTERS ON BABY'S LIPS)

LisaMc:
I just delivered my first on 7/7 and we are bf'ing. We met with the lactation consultant in the hospital so I already know that he has a really strong suck - although he latches on well - his bottom lip slides up while feeding and he ends up just getting the nipple after awhile (we are working on holding the bottom lip down). Anyway - here is my question. I can't tell if he has blisters on his top lip or if that is just the way his lips are (it's almost as if he is wearing lip liner - darker around the edges and then lower on his top lip the skin in lighter and looks bumpy - doesn't seem sore or to be bothering him). Is it possible that b/c of his strong sucking that he is causing blisters on his top lip? What would one do to correct/heal? Any advice/opinions are appreciated!

Marci:
Hi Lisa,

It sounds to me like something I've experienced with all three of my kids - their lips do tend to "blister" and peel in the beginning. Now I haven't experienced any problems like what you've described as far as the bottom lip sliding up, but with my kids, their lips got really bumpy looking, and then started peeling. I don't really remember if I did anything in particular for my first two (they are 7 and 8 now) but with my newest (one month old already on the 9th!!!), we just put a tiny bit of vaseline on her lips, and after two or three applications, all the bumps were gone, and we've not had any more trouble with it. It seemed to my dh and I that it really bothered Joyce, so that's when we decided to try the vaseline. And it worked!! You could also try Lansinoh - which actually I think would be better for baby, but we didn't know about that stuff until after we solved our problem!!! Lansinoh works great though on sore nipples!!

Well, I'm not sure if I was any help, but I sure hope so!! Again, congratulations and have fun with your new baby - they grow up SO QUICKLY!!!

Kenyatta :
When your son is latched on and nursing, BOTH of his lips should be turned outward ...almost like an open mouth pucker. You should be able to SEE his lips on your areola.

If his lips are turned inward, and you cannot see his lips, THAT may be the cause of any blistering, because of friction from sucking against your nipple.

When you insert your nipple, try to get his mouth to open as wide as possible, even if it means breaking the suck with your pinkie, and reinserting until he gets it right.

I used to rub my nipple across Christian's lips, until he opened wide enough, and then I'd stick it in!

Also, to be on the safe side, call your pede and/or LC too.

Cari:
Don't worry Lisa! It sounds like a classic "nursing blister", which is normal and doesn't hurt the baby. Both breastfed and bottlefed babies get these, they go away on their own. This even got a mention in "What to Expect the First Year" on page 106.

Common Nursing Problems

Breastfeeding may be natural, but it comes with it's own set of problems too. When your nipples are so it brings tears to your eyes; when your breasts are so full, you feel as if the slightest touch - and you'll explode....

It's enough to make you give up. You feel as if you're the only one not doing it right ...that everyone else seems to cruise through breastfeeding, but you. That's not the case at all. You can encounter any number of problems from thrush, mastisis, overactive letdown ... AT ANY TIME. It can be the first day - or your 500th day - no one is immune to experiencing difficulties nursing.

The difference in the the Mom who seems to breeze through, and the Mom who feels as if her back up against the wall is simple. Education.

The more you educate yourself in the Pro's and Con's of breastfeeding - the better equipped you'll be in handling the difficulties that can arise.