NIPPLE PAIN & DAMAGE, VASOSPASM, BREAST INFLAMMATION: Danielle and four-month-old Ivy. Dr Pamela Douglas, F2F Nova Health Co. October 2023

Danielle is mother of secondborn exclusively breastfed Ivy, who is four months old. Danielle has had persistent nipple pain and damage and also a recent episode of breast inflammation. She comes in for review at Nova Health Co, Wagga Wagga, Australia, 20 October 2023. A very big thank you to Danielle for the generous gift she has to given other breastfeeding women by consenting to participate in this education video and images.

The photo above shows inflammation and small cracks (2-3mm, 11 o'clock towards centre, also 2 mm wide break in epithelium at centre) on face of Danielle's left nipple. A magnifying glass can better help determine if the epithelium is broken - although what really matters is that you offer help to address the underlying cause of the pain and damage, rather than invest too much time (in time-constrained consultations) attempting to map difficult-to-visualise breaks in the epithelium.

The video below demonstrates management of

• Persistent left nipple pain and damage, including

  • Gestalt intervention, including use of facecloth roll to better expose landing pad

  • Vasospasm

  • Silverette use

  • Lansinoh and hydrogel disc use

  • Prevention of Moisture Associated Skin Damage

• Breast inflammation

• Weighing up weaning.

The video below shows the fit and hold I first saw Danielle using with baby Ivy. Can you identify indicators of nipple and breast tissue drag, which would explain why Danielle has persistent nipple pain and damage?

This photo below shows a much improved fit and hold. I have placed my hands on Danielle's forearm and am demonstrating micromovements, as she gives me feedback.