nipple pain - is apno the answer? - mcfp · •breastfeeding made simple: seven natural laws for...
TRANSCRIPT
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
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
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
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
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
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
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 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
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
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 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
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
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 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
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
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 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
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
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 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
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
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 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
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
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 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
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
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 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
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
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 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
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
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 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 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
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 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
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
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
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
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
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
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
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
wpgbreastfeedingcentrecom