Another issue to be aware of when there is a resistant infection of any 
kind is that nipple trauma makes the nipple more vulnerable to 
organisms. Check out what the baby is doing with that little tongue and 
see if that's contributing to mom's pain and susceptibility to 
infection. The moms in my practice who have had recurrent thrush despite 
2 week courses of fluconazole have had infants who latch shallowly, use 
excessive compression during sucking, and most had subtle tongue-ties 
that were not treated.

Treatment induced dermatitis also occurs, and can be hard to tell from 
the original infection if the mom is not examined again, but is just 
treated over the phone.

Catherine Watson Genna, IBCLC  NYC

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