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OW!

Posted by on Jun. 15, 2012 at 7:40 PM
  • 4 Replies

Ever since my 14 month old got teeth, her latch has been messed up. I'm not sure why, she's not biting me or anything, but when she nurses, it looks like she's chewing almost. I had her ped look at her mouth and she said nothing looked wrong, but something is up because my nipples shouldn't be cracked and bleeding. She got teeth around 9 months and my nipples have been cracked and bleeding since. I've tried everything I can think of, but nothing is working. I don't to wean her at all and have no intention of doing so, but I need to figure out why I'm in so much pain and she's not nursing properly. She had no issues until she got teeth.

A proud Christian, Republican, Breastfeeding, Attachment parenting, Cloth diapering, Extended Rear Facing and Extended Harnessing, ANTI- CRY IT OUT, mommy to my 4 girls and wife to my Marine
Abortion? What part of "Thou shalt NOT kill" don't you understand?
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by on Jun. 15, 2012 at 7:40 PM
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maggiemom2000
by Ruby Member on Jun. 15, 2012 at 7:59 PM

What have you done to try to heal the nipples? 5 months of cracked/bleeding nipples is a concern. I'm thinking you have an infection that needs to be treated and that it is lack of healing as opposed to repeated damage?

Baby should not be able to damage your nipples (no matter how many teeth she has) if she is latched on properly. Have you seen this info from kellymom.com? If not, have a read and see if any of it helps!

When Baby Bites

JULY 27, 2011. Posted in: OLDER INFANT

By Kelly Bonyata, BS, IBCLC

Will I need to wean when baby gets teeth?

Many people think that when baby gets teeth and has the ability to bite, then the nursing relationship has ended and it’s time to wean. Not true! If your baby is nursing properly, then you should not feel teeth, even if baby has a mouthful of them. And keep in mind that it’s physically impossible for baby to nurse and bite at the same time, because the tongue covers the bottom teeth/gum when baby is nursing.

Some babies never bite, but biting is a behavior that most babies do try, usually when they are teething. Rest assured that biting can be stopped with a little persistence on the mother’s part. Biting is, for the vast majority of moms, a temporary issue that only lasts a few days to a couple of weeks.

All babies are different, so you may need to try several different things before you find something that works for you. What works for you will depend on your baby’s age, temperament and personality.

Many mothers have gotten through this stage and gone on to give their babies the wonderfulbenefits of breastfeeding for weeks, months, and even years afterward.

Ways to PREVENT biting

  1. Biting at the end of a nursing session: Biting often takes place at the end of a nursing session when baby is getting bored and is no longer hungry. If you start to have a biting problem, watch for signs of boredom, and take baby from the breast before the biting starts. Also, watch for tension in baby’s jaw before he starts to bite down. He may also pull his tongue back from it’s normal position over the lower gum/teeth.
  2. When baby is teething: Biting can also be brought on by teething. If baby seems to be teething rather than wanting to nurse, offer her a teething toy or something cold to bite (instead of you). Offer baby a teething toy after a bite or “near miss.” When you do this, tell her, “This is for biting. Be gentle when you nurse.” See also these comfort measures for teething.
  3. When my oldest was teething, I could tell whether my baby felt like biting or nursing by offering her a finger (careful!) or a toy before nursing – she would either suck or bite.

  4. Biting at the beginning of a nursing session: If baby is biting at the beginning of a nursing session, make sure baby opens wide when latching on. If your teething baby is biting at the beginning of a nursing session, try giving her a teething toy or something cold to chew on before nursing. Praise baby when she latches on correctly, without biting.
  5. Distracted baby: When baby is distracted, don’t force a nursing. If he’s wriggling, rolling, or pushing against you with his arms, he may not be hungry or interested in nursing. Try lying down with him in a quiet room, walking or rocking. See also these tips for nursing distracted babies.
  6. Biting for attention: Focus your attention on your baby while nursing, if you’re having a problem with biting. Some older babies will bite for attention. Paying attention will also help you to be aware of when baby is about to bite.
Use positive reinforcement and praise for good latch on and careful unlatching. Even the youngest babies can learn to nurse properly when mom uses gentle encouragement.

What do I do if baby bites me?

If baby bites, it can be very effective to calmly remove baby from the breast and saynothing (or perhaps make a calm comment like “oh? don’t want to nurse right now?”), then end the nursing session for a bit.

 

Stopping the nursing session is generally the most effective way to teach baby that nursing and biting do not go together. Once baby lets go, remove her from the breast for a bit – it may be a few seconds or a few minutes (this is something where you’ll need to gauge your own baby’s reaction). If baby is teething (which is often the cause of biting), this is a good time to hand baby something cold to chew on, a teething toy, etc. You might tell baby something along the lines of, “if you want to bite, we’re not nursing.” If baby really wants to keep nursing, she may get upset when you end the nursing session, at which point you can wait a few moments then give baby another chance to nurse. If baby is not interested in nursing, she might fuss a few seconds but then go on to something else.

If baby bites, it’s not a good idea to scream or yell on purpose as a method to stop biting — there are better ways to teach baby not to bite. Sometimes, of course, it’s impossible not to yell in pain if baby catches you by surprise and/or bites hard. Sometimes yelling does stop baby from biting again; however, some babies think it’s so funny that they continue to bite for the reaction, and other babies are so scared that they go on a nursing strike. The chance that this method will stop baby biting is simply not worth the problems it can cause.

If your baby bites down and doesn’t let go (most let go immediately without mom doing anything), there are a couple of things you can do: First, quickly place your finger between baby’s gums so you can pull away without (more) injury. If that doesn’t work, pull baby TOWARD you, very close to your breast. This will make it a little hard to breathe, so baby will automatically let go to open her mouth more and uncover her nose to breathe. A variation of this that some moms use is to gently pinch baby’s nose closed for just a second to get her to open her mouth and release the nipple.

Suggestions from other moms

“A baby cannot suck for milk and bite simultaneously. When I start to nurse my son, I watch him intently. As soon as he stops sucking, I take him off the breast and talk to him gently for a minute before I let him resume.”

“My baby had two reasons for biting: either he was not hungry or not interested in nursing – he was distracted or bored. I switch sides during a feeding or move to a different chair or position.”

“What worked best for me was to be very vigilant during nursing sessions – no more reading magazines or watching TV. By watching carefully, I could tell when my son was beginning to lose interest, and I could remove him from the breast.”

“My baby begin biting when I became pregnant with my second child (even before I realized I was pregnant). I’m not sure why – perhaps my milk supply had already decreased due to the pregnancy.”

“The time when I yelled out in pain, it scared my daughter pretty badly (though not into a nursing strike). The few times that she bit after that, I just gritted my teeth and calmly said “no bite – that hurts Mama!” When my son tried biting, I found it was just as effective to say nothing (or perhaps make a calm comment like “oh? don’t want to nurse right now?”), then calmly remove him from the breast for a bit.”

“Be sure you don’t use any teething gels or lotions just prior to breastfeeding, since it can numb the baby’s tongue, and even your nipple & areola, making it difficult for baby to breastfeed.”

“If you think your baby may have pain from the teething ask your doctor about using a baby pain reliever (like Tylenol) 1/2 hour before nursing.”

Not really biting, but scraping teeth or indentations

Teeth scraping, uncomfortable latch, or indentations on your nipple tissue from the teeth is not all that uncommon. It seems to be worse for most moms right when the teeth first cut through, and before they have a chance to wear down some and become less sharp. Babies may also change their latch a bit when they get new teeth, as nursing can feel different to them with the new teeth. With time, baby will learn to nurse better with the new teeth and you won’t be so aware of them. Here are some suggestions that have helped other moms:

  • With an older baby, the weight of the baby can cause baby’s mouth and teeth to “drag down” on the breast tissue. See if you can position baby so that her weight is supported well. Use pillows or a chair with arm rests to support her as much as you can. When she is nursing on the left side, bring her bottom in a little bit closer and vice versa. Don’t let her nurse in a position that lets her weight and gravity cause her mouth to pull down on your breast and nipple. Try moving her body slightly in different ways (higher, lower, side to side, etc.) till the pressure on your breast is lessened.
  • Latch baby on and position her head so that it is tilted back more to get the pressure of the top teeth off your breast. For example, if baby is nursing in the cradle position on the left side, bring her body toward the right a bit. This will bring baby’s chin up, with her head a bit cocked back, and that moves the pressure of baby’s top teeth off the top of the nipple. Don’t let her chin rest on her chest.
  • Some other ways to get baby’s head tilted back more: ask your child to look at you while she nurses, or hold a book up high to read to your child and have her look at the book.
  • When you support your breast with 2-4 fingers underneath and thumb on top, push in against the chest wall with your index finger just before offering the breast. This will cause the nipple and areola to point down more, so that they don’t rub against baby’s upper teeth. This technique is often suggested for moms who have nipple soreness due to their nipples rubbing up against the roof of baby’s mouth.
  • Ask baby to open WIDE and show her with your own mouth. Tell her that it hurts mommy and ask her to try again until it feels better.
  • A generous application of lanolin before and after feeding may be helpful, as will rinsing your nipples with cool water after feedings. When babies are teething they produce more saliva which can be irritating to nipple tissue. If baby is eating solids, sometimes food particles left in the mouth can also irritate nipple tissue, so it may help to rinse out baby’s mouth or give baby a sip of water prior to nursing.
  • Any time you experience soreness, go back to the basics of latch just as you did in the early days.
  • It’s also possible that some of the tenderness is a result of ovulation or an impending menstrual period. Many moms of older babies are more bothered with latch on and baby’s teeth during these times.

See also:

If your baby bites you and causes damage to the nipple…

It never happens to most moms, but occasionally a mom will get a bad bite from baby. Applying ice right after the injury and between feedings can be very helpful. Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) are compatible with breastfeeding and can be used as needed. SeeHealing broken skin in the nipple area for additional information on healing.


mommyof2grls06
by on Jun. 15, 2012 at 8:15 PM

I've used coconut oil, lanolin, nystatin and GSE. I tried to get her to use a nipple shield for a bit, but that was a no go for her. I have shells that I've been wearing because the scabs stick to my bra and it hurts like crazy when my bra pulls them off. I've read the kellymom thing. Thanks. :-) I've never had this problem before with the other girls. They got their teeth, I felt them for about a day and they readjusted thier latch, no problem. I'm beginning to think that the doc was wrong. I think I'm going to see if we have a decent LC at the Naval hospital here. This makes me wish we weren't in Okinawa and we were back at Lejeune. The LC there was really good. 

maggiemom2000
by Ruby Member on Jun. 15, 2012 at 10:10 PM


Quoting mommyof2grls06:

I've used coconut oil, lanolin, nystatin and GSE. I tried to get her to use a nipple shield for a bit, but that was a no go for her. I have shells that I've been wearing because the scabs stick to my bra and it hurts like crazy when my bra pulls them off. I've read the kellymom thing. Thanks. :-) I've never had this problem before with the other girls. They got their teeth, I felt them for about a day and they readjusted thier latch, no problem. I'm beginning to think that the doc was wrong. I think I'm going to see if we have a decent LC at the Naval hospital here. This makes me wish we weren't in Okinawa and we were back at Lejeune. The LC there was really good. 

coconut oil, lanolin will do nothing to treat an infection. Nystatin rarely works, pretty useless. GSE should have had an affect if it was yeat/thrush, but it depends on how much you used it as well.

When nipples have been damaged for this long it is usually a bacterial infection, or a combination bacterial and yeasst infection. You need to treat it as if it is both. A doctor can prescribe APNO (all purpose nipple ointment) and you can get it filled at a compounding pharmacy. The next best thing is to make your own with over the counter (OTC) ingredients:

following solution can be used:  Miconazole (over the counter, OTC) hydrocortisone (OTC) polysporin antibacterial ointment (OTC).  Combine and use in small amounts after feeding, don’t need to wash it off before feeding.


All Purpose Nipple Ointment (APNO)PrintE-mail
We call our nipple ointment “all purpose” since it contains ingredients that help deal with multiple causes or aggravating factors of sore nipples. “Good medicine” calls for the single “right” treatment for the “right” problem, true enough, but mothers with sore nipples don’t have time to try out different treatments that may or may not work, so we have combined various treatments in one ointment. Of course, preventing sore nipples in the first place would be the best treatment and often adjusting how the baby takes the breast can do more than anything to decrease and eliminate the mother’s nipple soreness (See information sheets When Latching, Sore Nipples as well as the video clips at the website nbci.ca. 

The APNO contains:
  1. Mupirocin 2% ointment. Mupirocin (Bactroban is the trade name) is an antibiotic that is effective against many bacteria, particularly Staphylococcus aureus including MRSA (methicillin resistantStaphylococcus aureus). Staphylococcus aureus is commonly found growing in abrasions or cracks in the nipples and probably makes worse whatever the initial cause of sore nipples is. Interestingly, mupirocin apparently has some effect against Candida albicans (commonly, but inaccurately called “thrush” or “yeast”). Treatment of sore nipples with an antibiotic alone sometimes seems to work, but we feel that the antibiotic works best in combination with the other ingredients discussed below. Although mupirocin is absorbed when taken by mouth, it is so quickly metabolized in the body that it is destroyed before blood levels can be measured. Moreover most of it gets stuck to the skin so that very little is taken in by the baby. Thus it is safe for the baby to swallow if indeed he gets any.
  2. Betamethasone 0.1% ointment. Betamethasone is a corticosteroid, which like all corticosteroids, decreases inflammation. A large part of the pain mothers experience when they have sore nipples is due to inflammation. The redness of the nipples and areolas is another sign of inflammation. By decreasing the inflammation, the APNO also decreases the pain the mother feels. Most of the betamethasone in the ointment is absorbed into the skin by the mother, so that the baby takes in very little.
  3. Miconazole powder to a final concentration of 2%. Miconazole is an antifungal agent. It is very effective against Candida albicans. We feel the concentration of 2% miconazole is a good one, but because the pharmacist adds a powder to the above two ingredients, s/he can change the concentration of miconazole so that it can be increased to 3% or even 4% or decreased to less than 2%. We feel 2% is the best concentration for most situations. Fluconazole powder to 2% may be substituted for miconazole and so can clotrimazole powder to 2%, but we believe that clotrimazole (Canesten) irritates more than the other drugs in the same family. Miconazole cream or gel cannot be substituted for miconazole powder as the compound will usually separate. If you live in a place where miconazole or any of the above mentioned drugs (fluconazole, clotrimazole) are not easily available as powders to be mixed into the APNO, it is probably better to use only the mupirocin and betamethasone ointments mixed together than add a cream or gel or nystatin ointment for example.
By using a powder, the concentration of the other two ingredients is not as decreased as they would be if another ointment were used for the anti-fungal agent (for example, nystatin ointment). Thus, in the above preparation the concentration of the betamethasone become 0.05% (due to combination with the mupirocin) and the mupirocin concentration is decreased to 1%. Note that nystatin ointment, which we used to use and which decreases the concentration of the other ingredients, is far inferior to miconazole and also tastes bad.

I write the prescription this way. 
  1. Mupirocin ointment 2%: 15 grams
  2. Betamethasone ointment 0.1%: 15 grams
  3. To which is added miconazole powder to a concentration of 2% miconazole
Total: about 30 grams combined
Apply sparingly after each feeding. Do not wash or wipe off

NO SUBSTITUTIONS 

If possible, try to get the prescription filled at a compounding pharmacy. At least they will not tell you there is no such thing as miconazole powder. You can find a list of compounding pharmacies in Canada and the US and maybe some other countries by going to the website iacprx.org. Click “For Patients, Pet Owners” in the red box on the left side of the page, then click “Finding a Compounding Pharmacist Near You”. You will need to sign in and then you can find your nearest compounding pharmacy. Canadians: make sure that you leave a space between the two sets of 3 letters in the postal code: M2K 2E1, not M2K2E1.

How do I use the ointment?
  1. Apply it sparingly after each feeding. “Sparingly” means that you apply just enough to make the nipples and areola glossy or shiny.
  2. Do not wash it off or wipe it off, even if the baby comes back to the breast earlier than expected.
How long can I use the ointment?
Somehow the “word” has gotten around to use the ointment for only two weeks. This is unfortunate since many mothers are getting so much better, but not pain free, by the time they believe they have to stop the ointment. Apparently pharmacists have said that the steroid in the ointment will cause “thinning” of the skin. This is a concern with any steroid one puts on the skin, but in our experience this has not occurred with our ointment and many mothers have used it for months.

However, any drug should be used for the shortest period of time necessary, whether it’s taken by mouth or put on the skin or any other way it’s being given. The same is true for our ointment. There is no problem using the ointment for 2 or 3 or even more weeks, but if you still need the ointment after two or three weeks, or you pain returns after you have stopped it, you should get “hands on” help again to find out why and fix the way the baby is taking the breast, for example. Indeed, the most important feature of decreasing nipple pain is getting the “best latch possible”. Many teach a method of latching on that is different from what we teach. Naturally, based on our experience and from feedback, we think we have an effective and successful method. See the information sheet When Latching, and watch the video clips at the website and nbci.ca.
mommyof2grls06
by on Jun. 16, 2012 at 1:39 AM

Ok thanks! I will see about getting that stuff.


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