Hello, All.
I thought you might find this case interesting.
Mother of a 4 1/2-mo.-old contacted me on Friday, complaining of
constant ache in one breast, becoming excrutiating when she pumped. She had chills
the night before, though no fever when she called me. No red hotspots, but
still sounded like mastitis. We talked about using antibiotic if pain
persisted or if she ran a fever for 24 hrs. However, it was the holiday weekend
(Memorial Day on Monday, here in USA), so we were concerned about her getting worse
over the weekend and being unable to get a prescription from her dr. until
Tuesday when offices opened again. She decided to call him on Friday and ask
him to call in a prescription to her pharmacy, which she could get on Saturday
if things were not better (or worse), or not get if things were improving.
A little background: Baby is not coming to breast. Mom pumps and
bottle-feeds. When baby was 7 weeks, and mom was still attempting to breastfeed,
baby was given oral Diflucan for oral thrush. (I'm not sure if baby got 7
days or 10 days.) Mom was given one dose of Diflucan for nipple thrush.
Diflucan cleared up visible symptoms in baby's mouth and mother's nipples stopped
hurting. No trouble with thrush since then. And I was not involved in her care
at that time.
Back to the mastitis. On Tuesday, mother called me again. She said
she did indeed have mastitis and symptoms got worse, so she started antibiotic
on Saturday. She was calling now because she was upset because baby now has
thrush in her mouth again. Mom thought she must have yeast rather than
bacterial mastitis, and her baby got it from the pumped milk. She was ready to quit
pumping because this was just too much trouble if her milk was going to give
her baby thrush.
I told her that her symptoms matched mastitis much more than yeast
infection. I reminded her that although most medicines get into breastmilk in
very small amounts, they still *do* cross into the milk. I told her I thought
it was more likely that the *antibiotic* got to the baby through the milk, and
the antibiotic upset the balance in the baby so that she now had yeast again.
It was kind of funny. When mom figured that the *medicine* got to the baby
through the breastmilk (remember, baby is not coming to breast so could not
have picked up oral thrush from mom's nipples, and nipples aren't showing any
symptoms/pain anyway) and that the *medicine* caused the problem and the her
*breastmilk* didn't make the baby sick, she calmed down and figured she could
continue to pump and give the baby her breastmilk. Mom decided to finish her
antibiotic and contact baby's pediatrician for thrush medicine.
I am kind of tickled/puzzled/amazed about the mom's interpretation of
events here. If thrush in the milk made her baby sick, that would have just
been the last straw. But since medicine in the milk made her baby sick, her
milk was still OK, so she could deal with the problem.
But I am also surprised at how quickly that small amount of antibiotic
that reached the baby, pushed the baby "over the edge" and gave her visible
thrush in her mouth. I'm thinking that perhaps baby was never really "over"
the thrush infection two months ago, and it was lingering in baby at low levels
that could really jump at the opportunity that small amount of antibiotic
provided by killing off friendly bacteria.
Anyway, I found the situation interesting and thought you might, too.
Dee Kassing, BS, MLS, IBCLC
Collinsville, IL USA
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