Ladies - wanted to see if anyone has an idea of what I was looking at tonight.
I was called to the ED with a request for a nipple shield. Not wanting to
provide this without further info, I offered a consult. (The PA wasn't aware
this was an option)  Mom presented with 5 month old baby who has been
exclusively breastfed without difficulties to this point. Mom c/o fever,
malaise, etc. Her breasts appear normal - no reddess, but she feels some
firm areas that seem hot to touch to her - I didn't feel what she was
feeling. Her nipples, however are somewhat red and appear abraided all
around where the baby latches. She says they are quite painful with nursing
or pumping and crack and bleed at times. One pumping session, the milk had
so much blood she discarded it. Another, she allowed the milk to sit until
the blood could be separated from the milk to some degree. Her WBC count was
23K. Baby looks great, happy, plump, no sign of thrush, oral cavity overall
looks normal. Baby has not started any foods except rice cereal and that was
started after this problem began about 72 hours ago. I'm at a loss to
explain this. It doesn't "LOOK" like Mastitis, other than the elevated WBC
count and fever. The damage to her nipples looks to be a mechanical type
damage. She has no other symptoms that explain the fever and WBCs.  The PA
started her on antibiotics with DX of Mastitis. She was sent home with
nipple sheilds (her request) Lansinoh (I asked her to discard what she had)
instructions for RPS and instuctions to check with me by phone tomorrow. She
did give me permission to post. I'd be appreciative of any ideas.  Thanks so
much!   
Debra Ray, RNC, IBCLC

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