Hi, All -

Have a question for you out there regarding 2 moms I'm working with at the
present time. Both have a very similar problem that doesn't seem to be
responding to the usual treatment.  One mother's baby is 6 mos. old and the
other is 7 mos.  Both babies began sleeping through the nite at an early age
and now REALLY sleep all night - from 8 to 12 hours.  I consider that very
long, even for babies this age.  Both babies have been BFing usually only 4
times in 24 hrs. but seem to be gaining well.  Baby "C" weighed 7lb. 12 oz.
at birth and weighs 15 lb. 7 oz. at 7 mo.  Baby "C" began solids around 6
mo. but started off feeding "in place of" BF.  Mom stated baby ate LOTS of
cereal (I'll bet!). Corrected that situation immediately and mom began BF
before feeding cereal.  Baby "M" weighed 6 lb. 3 oz. at birth and weighs 12
lb. 4oz. at 6 mo. Baby "M" also began solids around 6 mo. with mom offering
before BF and switched to after BF when learned otherwise.  Baby "C" gets
one bottle ABM at nite after BF - Baby "M" gets a EBM bottle occassionally,
no more than once a day.

I've seen the mom of Baby "C" a couple of times - once for a consult and
twice to deliver a breast pump.  Have only talked to mom of Baby "M" over
the phone, although she has rented an electric pump from us (home health &
med. equip.) twice.  Both moms have had mastitis one time. Neither of the
moms smoke, have had breast surgery, are wearing underwire bras.  Getting
enough rest is a challange for both of them, but that has been suggested, as
well as cutting out/back on solids, BF more frequently, avoiding bottles and
being very diligent about applying heat/massage before BF and pumping
afterward for several days.

Both moms have a milk blister on the nipple of the affected (right) breast
that has been there almost since the beginning of BF. Remember: I have only
seen the mom of Baby "C", but what the other mom described to me sounded
like a milk blister, also.  Both moms have recurrent plugged ducts in the
right breast only. Using warm, moist heat and breast massage before BF,
pumping after BF is clearing up the plugged duct/lump but the milk blister
remains.  I have suggested, as in LLLI's BF Answer Book, to reduce the amt.
of saturated fat in the diet, try adding 1 TBS. of lecithin to diet daily
and check the amt. of sodium intake so it's not too much or too little.
That is the only thing that has been suggested that these moms have not
tried yet.  Does anyone know how long it would take to see results by
changing the diet?  Does anyone have any idea of any other causes/treatment
for a milk blister that is stubborn and doesn't respond to the usual?

I find it rather perplexing that this has gone on so long and wonder how the
babies could be growing well when BF so few times.  I've mentioned to both
mothers - that most babies that age would be BF more frequently, but that
doesn't seem to be troubling them, probably because their baby is growing
well AND mom is getting a full nite's rest.  It seems that by now their
bodies should have adjusted to the demands of the baby.  I'm wondering if
they both suffer from an overabundant supply?

Just for more consideration - Baby "C" was tongue-tied and had a frenotomy
at about one month of age, was a clencher when BF, but now has quit that
feeding behavior.  Baby "M" was jaundiced/re-hospitalized shortly after
birth, mom was only BF 7 times/24 hrs. at that time, but increased up to 8
times after phone consult. Baby "M" also makes a loud noise (doesn't sound
like clicking)-sounds like her tongue breaks suction from the roof of her
mouth with each suck.  She makes the same sound when sucking her thumb,
which she does for comforting herself back to sleep during the nite. Its so
loud that it can be heard distinctly over the phone while they are BF.  With
both moms, they've never had any nipple or breast problems in the left
breast throughout BF.

If anyone can help, we'd all appreciate it.

TIA,

Melody Engberg, IBCLC, LLLL
Methodist Alliance Health Services
Memphis, TN