<<-----Original Message-----
        I believe there are a number of breastfeeding problems that should
not
        be triaged over the phone, one being sore nipples.  I realize that
we
        often can only do phone triage due to the type of practice we have,
but
        I believe that moms should be referred to someone else in the
community
of breastfeeding counselors who can see them>>

As the bilingual IBCLC for WIC in Miami Florida, I often deal with sore
nipple cases over the phone.  There are way too many poor Hispanic women in
this town with sore nipples for me to see them all, and these women cannot
afford to pay for a consult.  Therefore, I do what I must and attempt to
resolve the soreness over the phone.  If that doesn't work in fairly short
order, then yes I do see them.  But honestly - if they call early enough
(within the first 3-4 weeks) - usually we can resolve it over the phone.
And one of my biggest points in my prenatal classes is to call EARLY.  The
earlier, the better.

Most of my moms with sore nipples simply need a good, detailed explanation
of how to latch the baby on.  They get that, over the phone ::grin::  I've
lost count of how many times in the past three years a woman has actually
done it WHILE on the phone with me and experienced pain-free breastfeeding
for the first time!  It's a marvel to me that they can latch the baby on and
hold the phone with their ear/shoulder at the same time, but they do.  It's
somewhat funny, actually, since I don't generally ASK them to attempt the
latch on while we're talking.  All I'm trying to do is explain it to them,
to try when we get off the phone.  But usually, when they hear me launch
into my description, they just silently grab the baby and start following my
step-by-step description.  I hear crying in the background.....then suddenly
no more crying <bg>.  Invariably when I ask at that point if the baby is on,
they say yes, and when I ask if it hurts, they say no.

This really can be done over the phone IMO, provided that the problem is
simple education about how to latch, and that your description is detailed,
clear, and simple to follow.  If there's a sucking problem, which will
become evident when phone assistance does not succeed, then yes they do need
to be seen IMO.......
Regina Roig Lane BS IBCLC for a LOT of phone-assisted happy breastfeeding
women in Miami-Dade County WIC

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