Dear Wise Ones,
A wonderful mother has a 3 week old baby who is healthy and thriving and has
such terrible sore breasts and nipples she can hardly bear to nurse. She
describes it as "burning" during and after nursings for at least 1/2 hour.
Right now I am baffled and need your collective wisedom.
Mom: Her breasts look blushed red and feel very warm for 2'' to 3'' back
from the areola and there are little red petechia like rash spots on one area
of each breast, but not all over. Breasts full and firm before feeding with
a couple of hard lumpy areas that soften up well with nursing and massage.
Nipples are pink but really look OK. No bruising, no scabs, no cracks, no
flaky, shiny skin. Mom had FUO (fever of unknown origin) during labor but it
went away quickly after delivery. She was on Keflex from delivery, then
amoxicillin for perineal pain "just in case" (she had a VBAC) although
nothing definite was diagnosed. Now she is on erythromycin (just the past 1
1/2 days) for her breasts, but doesn't feel any better yet, in fact a little
worse.
Baby: Is a beautiful, plump, happy, healthy boy, nursing like a little champ
and has gained 1 1/2 lbs in 3 weeks. He had a rough start, was in NICU for 9
day due to a pneumothorax (punctured lung) at birth, respiratory distress and
patent ductus. It closed fine and he got better quickly and loves to nurse!
Mom pumped the first 9 days then began nursing when baby got out of NICU and
began with the nipple and breast pain. We had our first consult at 2 weeks,
fixed some positioning and latch on techniques and things seemed to improve
for a few days. She had an oversupply and I attributed the reddness to this
because she was making much more milk than baby could take. Advised she wean
off pumping more sloooooly and let her supply drop gradually to the level of
1 baby's needs, not 2. She had tried to quit pretty quickly once the baby
began nursing so well.
Because of the burning the mother describes she is also treating with
nystatin in baby's mouth and lotrimin on her breasts for the past 5 days and
feels much worse!
We have never seen any thrush in baby's mouth.
She has seen the doctor, and me again today. Baby is not tongue-tied at all.
Nurses great and leaves only a very, very slight crease, not anything I
would ordinarily worry about. Takes lots into his mouth, mom is trying
really hard and follows directions faithfully and well.
HELP!
Could she and/or he have gotten some strange bug in the hospital?
Could contact dermatitis be this bad? We did recommend she change
detergents, double rinse bras and cotton pads, and mainly leave them off for
now. Has not been allergic or sensitive during her life.
I talked to the family practice doctor today--very nice and caring--he's
stumped too!
He and I both think it does not look like dermatitis.
Should she have her milk cultured?
She is taking ibuprophen to reduce inflamation.
Gentian violet?
I'm afraid she will get worse and am very worried about full blown masitis
that won't respond to anything because she has already been on so much and
had this problem over 1 week. She has been so determined to nurse this baby
and sees him thriving and just doesn't want to hurt.
Help, Help!
Many thanks. Please respond quickly
Jane Bradshaw RN, BSN, IBCLC
Private Practice in Lynchburg, VA
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