Hi Penny
I think I would try this:
- different position (since she almost always uses cradle); try laid back
or football
- treat for a staph infection (oral medication more important than topical)
which is the most likely, or culture and treat per culture results;
remember when nipple pain or
  injury doesn't heal it is often a bacterial infection (you say there is a
scab being ripped off)
- discontinue APNO, it doesn't seem to be working and may be delaying more
effective treatment
- I have found most mothers to report very good relief with the use of
hydrogel pads; there are several brands out there.
   In this case I would be recommending them just for mother's relief of
pain.
- if she is not adverse to taking or allergic she can take ibuprofen or
naproxen around the clock per label directions for next few days
- express by hand to elicit MER prior to latching, every time

Laurie Wheeler RN MN IBCLC
Mississippi USA






Thoughts?

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