Nipple Pain - Is APNO

The Answer

DR CHRISTINA RAIMONDI MD CCFP IBCLC

DR KATHERINE KEARNS MD CCFP IBCLC

APRIL 11 2019

Disclosuresbull Dr Raimondi and Dr Kearns have no conflict of interest

to disclose

bull We are two Family Doctors who are passionate about

breastfeeding because we believe it can save the world

The World Health Organization recommends

Exclusive Breastfeeding x 6 mo then continued

Breastfeeding + food to 2 years and beyond

Core Objectives

1 Improve community access and provide evidence based diagnostic help for moms and babies struggling to breastfeed in Manitoba communities

2 Be leaders for Breastfeeding Education in medical training and for those practicing

3 Contribute to Breastfeeding Research

Nipple Pain

Is APNO the answer

1 Review how to assess and teach latch

2 Learn how to approach and treat nipple pain and save the breastfeeding relationship

3 Learn about the impact of tongue tie how to approach and how to treat

Objectives

CONTEXT - NIPPLE PAIN

bullincidence - 34 and 96

bull2nd Most common reason to wean

bullpain inhibits oxytocin

bullartificial milk and bottles

bulldepressionanxiety - but BF = less

PPD

Raspberry nipple ( trauma)

What is APNO

All Purpose Nipple Ointment

Compound COST $65 for 30 g

anti-bacterial anti-fungal steroid

Dr Jack Newman ldquoPlease note that the all-purpose

nipple ointment is a stop gap measure only and that the definitive treatment of sore nipples is to help the

baby latch on as well as possiblerdquo

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

Disclosuresbull Dr Raimondi and Dr Kearns have no conflict of interest

to disclose

bull We are two Family Doctors who are passionate about

breastfeeding because we believe it can save the world

The World Health Organization recommends

Exclusive Breastfeeding x 6 mo then continued

Breastfeeding + food to 2 years and beyond

Core Objectives

1 Improve community access and provide evidence based diagnostic help for moms and babies struggling to breastfeed in Manitoba communities

2 Be leaders for Breastfeeding Education in medical training and for those practicing

3 Contribute to Breastfeeding Research

Nipple Pain

Is APNO the answer

1 Review how to assess and teach latch

2 Learn how to approach and treat nipple pain and save the breastfeeding relationship

3 Learn about the impact of tongue tie how to approach and how to treat

Objectives

CONTEXT - NIPPLE PAIN

bullincidence - 34 and 96

bull2nd Most common reason to wean

bullpain inhibits oxytocin

bullartificial milk and bottles

bulldepressionanxiety - but BF = less

PPD

Raspberry nipple ( trauma)

What is APNO

All Purpose Nipple Ointment

Compound COST $65 for 30 g

anti-bacterial anti-fungal steroid

Dr Jack Newman ldquoPlease note that the all-purpose

nipple ointment is a stop gap measure only and that the definitive treatment of sore nipples is to help the

baby latch on as well as possiblerdquo

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

Core Objectives

1 Improve community access and provide evidence based diagnostic help for moms and babies struggling to breastfeed in Manitoba communities

2 Be leaders for Breastfeeding Education in medical training and for those practicing

3 Contribute to Breastfeeding Research

Nipple Pain

Is APNO the answer

1 Review how to assess and teach latch

2 Learn how to approach and treat nipple pain and save the breastfeeding relationship

3 Learn about the impact of tongue tie how to approach and how to treat

Objectives

CONTEXT - NIPPLE PAIN

bullincidence - 34 and 96

bull2nd Most common reason to wean

bullpain inhibits oxytocin

bullartificial milk and bottles

bulldepressionanxiety - but BF = less

PPD

Raspberry nipple ( trauma)

What is APNO

All Purpose Nipple Ointment

Compound COST $65 for 30 g

anti-bacterial anti-fungal steroid

Dr Jack Newman ldquoPlease note that the all-purpose

nipple ointment is a stop gap measure only and that the definitive treatment of sore nipples is to help the

baby latch on as well as possiblerdquo

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

Nipple Pain

Is APNO the answer

1 Review how to assess and teach latch

2 Learn how to approach and treat nipple pain and save the breastfeeding relationship

3 Learn about the impact of tongue tie how to approach and how to treat

Objectives

CONTEXT - NIPPLE PAIN

bullincidence - 34 and 96

bull2nd Most common reason to wean

bullpain inhibits oxytocin

bullartificial milk and bottles

bulldepressionanxiety - but BF = less

PPD

Raspberry nipple ( trauma)

What is APNO

All Purpose Nipple Ointment

Compound COST $65 for 30 g

anti-bacterial anti-fungal steroid

Dr Jack Newman ldquoPlease note that the all-purpose

nipple ointment is a stop gap measure only and that the definitive treatment of sore nipples is to help the

baby latch on as well as possiblerdquo

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

CONTEXT - NIPPLE PAIN

bullincidence - 34 and 96

bull2nd Most common reason to wean

bullpain inhibits oxytocin

bullartificial milk and bottles

bulldepressionanxiety - but BF = less

PPD

Raspberry nipple ( trauma)

What is APNO

All Purpose Nipple Ointment

Compound COST $65 for 30 g

anti-bacterial anti-fungal steroid

Dr Jack Newman ldquoPlease note that the all-purpose

nipple ointment is a stop gap measure only and that the definitive treatment of sore nipples is to help the

baby latch on as well as possiblerdquo

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

What is APNO

All Purpose Nipple Ointment

Compound COST $65 for 30 g

anti-bacterial anti-fungal steroid

Dr Jack Newman ldquoPlease note that the all-purpose

nipple ointment is a stop gap measure only and that the definitive treatment of sore nipples is to help the

baby latch on as well as possiblerdquo

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

What is the Evidence for APNO

Dennis CL RCT apno vs lanolin n=151 painful damaged nipples

1 week after randomization= NO DIFFERENCE in PAIN SCORES

lanolin group reported satisfaction with feeding method higher BF

duration exclusivity 12 weeks pp

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

If not APNO then what

bull A HISTORY

bull A PHYSICAL EXAM

bull A DIAGNOSIS

bull A TREATMENT

bull A FOLLOW UP

bull Help from an IBCLC

bull Remember there are 2 patients Mom and Baby

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

NIPPLE PAIN

From 1st latch

When did it start

Started later on

BAD LATCH

LEARNING

ANATOMIC

baby

mom

Mom flat nippleengorgement

Baby tongue tiemouth shape

TRAUMA

VASOSPASM

LATCH

TRAUMA

BLEB

DERMATITIS

INFECTION

Hx eczema psoriasis

contact derm Pagets

Rxn to topical cream

White spot on nipple - blocked

Duct -needs unroofing

Whats new Pumping biting

distracted babe

Moms and

babies are

learning

Teach them

how

Early trauma can Make pain persist despite correction Any break in skin can put mom

At risk of infection

Viral bacterial yeast

Has something changed

Latch more shallow

This pain is typically immediately after latch is released Can be during feed

Can last 1-2 hours Nipple will turn white Then dark purple as the flow returns

Ask about pain coming out of a shower

VASOSPASM TIP do

Bhcg

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

LATCH - Teaching the Latch

bull Compress breast near areola

bull Baby to breast tummy to tummy

bull Support baby at shoulder blades

bull Nipple to nose

bull Chin first into breast

bull Help baby bring upper jaw on

bull Push nipple into mouth

bull Hips in to free nose

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

Assessing the latch

bull When baby

unlatches -

nipple should

be round

bull Creased or lipstick shape

= not deep enough

bull Nipple hard palate =

squished and trauma

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

LATCH - Assessing the LatchA good deep asymmetric latch LATCH ON PAIN FREE

bull L- Lips are flanged out ~150 degrees

bull A-ANGLE - Babyrsquos head is extended

bull T- Tongue is extended to cover the lower gums

bull C- Chin is touching the lower breast

bull H- hand not on back of babyrsquos head

bull O- Open mouth has whole nipple and most of the bottom of areola

bull N- nose is free to breathe

bull PAIN FREE

bull LISTEN FOR SWALLOWS

Of note - clicking when feeding is a potential sign that the seal is being

broken

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

Latch

bull Signs baby is swallowing milk

httpswwwbreastfeedinginccavideosreally-good-

drinking

bull The exagerated latch technique (flipple)

httpswwwyoutubecomwatchv=deKN3wJ17Mk

bull Short flipple video

httpswwwyoutubecomwatchv=OGttPTx7iSsampfeature

=related

Nipple Wounds

Nipple Wounds That Wonrsquot Heal

bull FIX LATCH REMOVE TRAUMA = prevent infection

bull AVOID Irritants + Steroids (Like APNO)

bull MOIST WOUND HEALING (lanolin breastmilk)

bull KEEP WOUND CLEAN Saline soaks pat dry

bull PAIN CONTROL (NSAIDS)

bull Watch for underlying infection

bull Option to exclusively pumpexpress until healed

bull Fu reassess ddx

Type to enter a

caption

Promoting wound healing

bull Nursicare pads

Medihoney cotton

washable breast pads

bull Hydrogel pads

bull infection risk

bull Polyethylene FILM

bull LLLT - Low Level Laser

Therapy ($$ physio)

NIPPLE INFECTIONS Fix the initial trauma

VIRAL

Usually HSV (Can be HFM-coxsackie)

Hx previous episodes on nipple or

elsewhere

Episodes on partner

Looks like vesiclesulcers

SwabCulture if unsure

can cause death in infants

TX Pump to save supply

Avoid direct feeding on

affected side

BACTERIAL

Usually Staph other skin

bugs

Hx trauma looks like

redness yellow puscrusts

can lead to mastitis and

abscess

TX no systemic sx - topical

abx

Consider oral if not resolving

or has progressed

YEASTUsually candida Hx antibiotic use diabetes thrush lesions on baby (mouth or bum) Shooting pain to chest wall can affect baby too (pain latch wt)

TX treat mom + babymom Oral Fluconazole 400mg loading then 200mg OD until pain free (2-4 wks)Or topical Miconazole Q post feeds Baby Fluconazole solution or Nystatin (some resistance) Paint babyrsquos mouth after every feed Wash all pacifiers teats if using

VASOSPASM

- heat massage

- Vitamin B6 100mg BID until pain free 2 wks

- Mg 300mg BID until pain free 2 wks

- Nifedipine XL PO 20-30mg OD x 2 wks

- If pain returns (10) try 2 weeks again

ECZEMA

-topical steroid ointPSORIASIS

-topical steroid oint

Milk Bleb amp Blocked Duct -gt Mastitis

bull Empty Empty Empty

bull NSAIDS BF positions

bull Blocked Duct heat pressure vibration physio (Donna Sarna Prairie Trails

Creekside)

bull Bleb moist heat triamcinolone 01

olive oil abrasion Lecithin 1200mg QID

bull Mastitis (fever myalgias gt24 hours red streaking pain) add Keflex 500mg QID

10 days

bull Abscess needs surgical drainage

bull Recurrent Mastitis - think MRSA abscess cancer

BLEB=Blocked Duct MASTITIS

ABSCESS

DRAINED ABSCESS

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

Nipple Wounds That Wonrsquot Heal

bull FIX LATCH REMOVE TRAUMA = prevent infection

bull AVOID Irritants + Steroids (Like APNO)

bull MOIST WOUND HEALING (lanolin breastmilk)

bull KEEP WOUND CLEAN Saline soaks pat dry

bull PAIN CONTROL (NSAIDS)

bull Watch for underlying infection

bull Option to exclusively pumpexpress until healed

bull Fu reassess ddx

Type to enter a

caption

Promoting wound healing

bull Nursicare pads

Medihoney cotton

washable breast pads

bull Hydrogel pads

bull infection risk

bull Polyethylene FILM

bull LLLT - Low Level Laser

Therapy ($$ physio)

NIPPLE INFECTIONS Fix the initial trauma

VIRAL

Usually HSV (Can be HFM-coxsackie)

Hx previous episodes on nipple or

elsewhere

Episodes on partner

Looks like vesiclesulcers

SwabCulture if unsure

can cause death in infants

TX Pump to save supply

Avoid direct feeding on

affected side

BACTERIAL

Usually Staph other skin

bugs

Hx trauma looks like

redness yellow puscrusts

can lead to mastitis and

abscess

TX no systemic sx - topical

abx

Consider oral if not resolving

or has progressed

YEASTUsually candida Hx antibiotic use diabetes thrush lesions on baby (mouth or bum) Shooting pain to chest wall can affect baby too (pain latch wt)

TX treat mom + babymom Oral Fluconazole 400mg loading then 200mg OD until pain free (2-4 wks)Or topical Miconazole Q post feeds Baby Fluconazole solution or Nystatin (some resistance) Paint babyrsquos mouth after every feed Wash all pacifiers teats if using

VASOSPASM

- heat massage

- Vitamin B6 100mg BID until pain free 2 wks

- Mg 300mg BID until pain free 2 wks

- Nifedipine XL PO 20-30mg OD x 2 wks

- If pain returns (10) try 2 weeks again

ECZEMA

-topical steroid ointPSORIASIS

-topical steroid oint

Milk Bleb amp Blocked Duct -gt Mastitis

bull Empty Empty Empty

bull NSAIDS BF positions

bull Blocked Duct heat pressure vibration physio (Donna Sarna Prairie Trails

Creekside)

bull Bleb moist heat triamcinolone 01

olive oil abrasion Lecithin 1200mg QID

bull Mastitis (fever myalgias gt24 hours red streaking pain) add Keflex 500mg QID

10 days

bull Abscess needs surgical drainage

bull Recurrent Mastitis - think MRSA abscess cancer

BLEB=Blocked Duct MASTITIS

ABSCESS

DRAINED ABSCESS

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

Promoting wound healing

bull Nursicare pads

Medihoney cotton

washable breast pads

bull Hydrogel pads

bull infection risk

bull Polyethylene FILM

bull LLLT - Low Level Laser

Therapy ($$ physio)

NIPPLE INFECTIONS Fix the initial trauma

VIRAL

Usually HSV (Can be HFM-coxsackie)

Hx previous episodes on nipple or

elsewhere

Episodes on partner

Looks like vesiclesulcers

SwabCulture if unsure

can cause death in infants

TX Pump to save supply

Avoid direct feeding on

affected side

BACTERIAL

Usually Staph other skin

bugs

Hx trauma looks like

redness yellow puscrusts

can lead to mastitis and

abscess

TX no systemic sx - topical

abx

Consider oral if not resolving

or has progressed

YEASTUsually candida Hx antibiotic use diabetes thrush lesions on baby (mouth or bum) Shooting pain to chest wall can affect baby too (pain latch wt)

TX treat mom + babymom Oral Fluconazole 400mg loading then 200mg OD until pain free (2-4 wks)Or topical Miconazole Q post feeds Baby Fluconazole solution or Nystatin (some resistance) Paint babyrsquos mouth after every feed Wash all pacifiers teats if using

VASOSPASM

- heat massage

- Vitamin B6 100mg BID until pain free 2 wks

- Mg 300mg BID until pain free 2 wks

- Nifedipine XL PO 20-30mg OD x 2 wks

- If pain returns (10) try 2 weeks again

ECZEMA

-topical steroid ointPSORIASIS

-topical steroid oint

Milk Bleb amp Blocked Duct -gt Mastitis

bull Empty Empty Empty

bull NSAIDS BF positions

bull Blocked Duct heat pressure vibration physio (Donna Sarna Prairie Trails

Creekside)

bull Bleb moist heat triamcinolone 01

olive oil abrasion Lecithin 1200mg QID

bull Mastitis (fever myalgias gt24 hours red streaking pain) add Keflex 500mg QID

10 days

bull Abscess needs surgical drainage

bull Recurrent Mastitis - think MRSA abscess cancer

BLEB=Blocked Duct MASTITIS

ABSCESS

DRAINED ABSCESS

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

NIPPLE INFECTIONS Fix the initial trauma

VIRAL

Usually HSV (Can be HFM-coxsackie)

Hx previous episodes on nipple or

elsewhere

Episodes on partner

Looks like vesiclesulcers

SwabCulture if unsure

can cause death in infants

TX Pump to save supply

Avoid direct feeding on

affected side

BACTERIAL

Usually Staph other skin

bugs

Hx trauma looks like

redness yellow puscrusts

can lead to mastitis and

abscess

TX no systemic sx - topical

abx

Consider oral if not resolving

or has progressed

YEASTUsually candida Hx antibiotic use diabetes thrush lesions on baby (mouth or bum) Shooting pain to chest wall can affect baby too (pain latch wt)

TX treat mom + babymom Oral Fluconazole 400mg loading then 200mg OD until pain free (2-4 wks)Or topical Miconazole Q post feeds Baby Fluconazole solution or Nystatin (some resistance) Paint babyrsquos mouth after every feed Wash all pacifiers teats if using

VASOSPASM

- heat massage

- Vitamin B6 100mg BID until pain free 2 wks

- Mg 300mg BID until pain free 2 wks

- Nifedipine XL PO 20-30mg OD x 2 wks

- If pain returns (10) try 2 weeks again

ECZEMA

-topical steroid ointPSORIASIS

-topical steroid oint

Milk Bleb amp Blocked Duct -gt Mastitis

bull Empty Empty Empty

bull NSAIDS BF positions

bull Blocked Duct heat pressure vibration physio (Donna Sarna Prairie Trails

Creekside)

bull Bleb moist heat triamcinolone 01

olive oil abrasion Lecithin 1200mg QID

bull Mastitis (fever myalgias gt24 hours red streaking pain) add Keflex 500mg QID

10 days

bull Abscess needs surgical drainage

bull Recurrent Mastitis - think MRSA abscess cancer

BLEB=Blocked Duct MASTITIS

ABSCESS

DRAINED ABSCESS

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

VASOSPASM

- heat massage

- Vitamin B6 100mg BID until pain free 2 wks

- Mg 300mg BID until pain free 2 wks

- Nifedipine XL PO 20-30mg OD x 2 wks

- If pain returns (10) try 2 weeks again

ECZEMA

-topical steroid ointPSORIASIS

-topical steroid oint

Milk Bleb amp Blocked Duct -gt Mastitis

bull Empty Empty Empty

bull NSAIDS BF positions

bull Blocked Duct heat pressure vibration physio (Donna Sarna Prairie Trails

Creekside)

bull Bleb moist heat triamcinolone 01

olive oil abrasion Lecithin 1200mg QID

bull Mastitis (fever myalgias gt24 hours red streaking pain) add Keflex 500mg QID

10 days

bull Abscess needs surgical drainage

bull Recurrent Mastitis - think MRSA abscess cancer

BLEB=Blocked Duct MASTITIS

ABSCESS

DRAINED ABSCESS

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

Milk Bleb amp Blocked Duct -gt Mastitis

bull Empty Empty Empty

bull NSAIDS BF positions

bull Blocked Duct heat pressure vibration physio (Donna Sarna Prairie Trails

Creekside)

bull Bleb moist heat triamcinolone 01

olive oil abrasion Lecithin 1200mg QID

bull Mastitis (fever myalgias gt24 hours red streaking pain) add Keflex 500mg QID

10 days

bull Abscess needs surgical drainage

bull Recurrent Mastitis - think MRSA abscess cancer

BLEB=Blocked Duct MASTITIS

ABSCESS

DRAINED ABSCESS

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

Tongue Tie

bull No standardized dx tool

bull Up to 10 of babies MgtF

bull 25 BF trouble 3 of babies wo

(MESSNER 2000)

bull may not be an isolated issue or the

issue at all

FIrst - Is there a problem - pain wt gain This baby did not have

any breastfeeding problems

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

Tongue Tie

bull httpswwwdrghahericomblog2014215how-to-

examine-a-baby-for-tongue-tie-or-lip-tie

bullFull Evaluation - FUNCTION and FIT not APPEARANCE

Evaluate the latch Look at the nipple + babyrsquos mouth

bull 4 movements of the tongue

bull LIFT- tip to upper gum ridge mid tongue to roof of mouth

bull EXTENSION-over lower gum ridge amp lower lip

bull CUPPING- form a central groove

bull LATERALIZATION- sideways movement

Tongue Tie

bull Frenotomy - simple = save BF relationship

bull If you are not sure ask an IBCLC

bull Peds dentists - charge 700+ dollars

bull Dr Melanie Morris - Paediatric surgery -

prioritizes

bull BF immediately post-op - often

immediate benefit

bull Post frenotomy exercises - help

bull httpswwwdrghahericomaftercare

Resources for mom when things get

confusing hard amp exhaustingbull Websites

bull Baby Friendly MB httpswwwgovmbcahealthbfmindexhtml

bull Healthy Baby MB httpswwwgovmbcahealthychildhealthybabycsphtml

bull call 204-945-1301 (in Winnipeg) or 1888 848 0140

bull lllcca 204-257-3509

bull Kellymomcom

bull Nancymorbachercom

bull Books

bull Breastfeeding Made Simple Seven Natural Laws for Nursing Mothers (Nancy Mohrbacher and

Kathleen Kendall-Tackett)

bull The Womanly Art of Breastfeeding (LLLI)

bull JACK NEWMAN - Empowering Parents Jack Newmanrsquos Guide to BF

bull SWEET SLEEP (LLLI)

Resources for mom when things get

confusing hard amp exhausting

bull Local Support

bull La Leche League Canada (Online in personphone) lllcca 204-257-3509

bull BREASTFEEDING DROP-IN SUPPORT

httpwwwwrhambcabreastfeedingclinicsphp

bull COPING WITH CHANGE (Birth Centre) 204-947-2422 ext 113 or

email mothersprogramwomenshealthclinicorg

bull CMHA - free workshop called not just mamas NEW - starting April 24th - May

30 on portage ave Website mbwpgcmhaca Phone 204-982-6355 E-mail

CKendelcmhawpgmbca

Resources for mom when things get

confusing hard amp exhausting

bull Local Professional Support

bull Public health (home visits by RNrsquos and assessment with lactation

consultant)

bull BREASTFEEDING HOTLINE 204-788-8667

bull Private pay LCrsquos in the Community

httpswwwbirthrootsdoulascombreastfeeding-1

bull Winnipeg Breastfeeding Centre (FREE for families Covered by MB HEALTH)

bull wwwwpgbreastfeedingcentrecombull On FACEBOOK

Resources for Healthcare Providers

bull bfmedorg (Academy of Breastfeeding Medicine )

bull INFANTRISK (APP) wwwinfantriskcom LactMed

bull Jack Newman Website wwwBreastfeedingincca wwwibconlineca

bull breastmilksolutionscom

bull drghahericom

bull wwwwpgbreastfeedingcentrecom

bull kellymomcom

Resources for this talk 1 Wilson-Clay Hoover The Breastfeeding Atlas sixth edition (PHOTO CREDIT)

2 Jacqueline C Kent Nipple Pain in Breastfeeding Mothers Incidence Causes and

Treatments Int J Environ Res Public Health 2015 Oct 12(10)

3 Azin Niazi A Systematic Review on Prevention and Treatment of Nipple Pain and Fissure

Are They Curable J Pharmacopuncture 2018 Sep 21(3) 139ndash150

4 Dennis CL An all-purpose nipple ointment versus lanolin in treating painful damaged

nipples in breastfeeding women a randomized controlled trial Breastfeeding

medicine The official journal of the Academy of Breastfeeding Medicine 20127(6)473ndash9

5 Coca KP Efficacy of low-level laser therapy in relieving nipple pain in breastfeeding

women a triple-blind randomized controlled trial Pain Management

Nursing 201617(4)281ndash289

6 Miranda L Buck Nipple Pain Damage and Vasospasm in the First 8 Weeks

PostpartumBreastfeed Med 2014 Mar 1 9(2) 56ndash62

7 Dennis CL Interventions for treating painful nipples among breastfeeding

8 women Cochrane Database of Systematic Review 2014 Issue 12

9 Ziemer MMEvaluation of a dressing to reduce nipple pain and improve nipple skin

condition in breast-feeding women Nursing research 199544(6)347ndash51

11La Leche League International Website

12 httpsibconlineca (Jack Newman Website )

Anyone still awake

wpgbreastfeedingcentrecom