Anne, I agree with your clarification. The couple of moms whom I have seen with the blanching nipple problem usually blanched rather spontaneously *after* nursing, and it was apparent that the phenomenon was NOT suck related; the nipple looked fine coming out of the baby's mouth. I have concluded that it is the temperature change, the coldness, that seems to set it off, and this occurs so naturally when a wet nipple is exposed to air! (you know, like getting out of a swimming pool, even when the air is nice) Yes, it can happen at other times, too, like when changing clothes or having a car air conditioner blowing on the chest. So far, heat has been the only soother I have seen, and even that does not resolve the pain all of the time. Thanks for adding your insights. BTW- did the rheumatologist mention what she does to help these mothers, if she does see them? I am curious! -Lisa ****************************************************************************** Lisa A. Marasco, IBCLC / [log in to unmask] International Board Certified Lactation Consultant / [log in to unmask] ******************************************************************************