Hello wise ones. :) This is my first time posting to the group though I've read many posts and have been grateful for this wonderful resource.

Permission to share. I'm working with a mom of a 2 month old infant who is having persistent nipple pain. Normal pregnancy and birth were followed by pain during the first feed, similar to what mom has experienced with previous babies. With previous babies, the pain has resolved itself within a few weeks but this time around things are getting worse instead of better.

During our consult, I felt confident that the situation was a combination of thrush and poor latch. Prior to meeting with me, mom had just used Gentian Violet for three days and had reduced the pain from deep stabbing pain that radiated up to her shoulder down to being just localized at the nipple. She had discontinued use of APNO due to burning pain. Nipple was red and swollen but has now gone back to normal shape and colour. Mom had worked through two plugged ducts in the same location during the previous two weeks.

Assessment of the infant didn't reveal anything abnormal. Feed was observed on the non-painful side only. Good milk transfer took place though baby struggled at times to keep up to the fast flow of milk.

For the past four days mom has been using grapefruit seed extract and coconut oil topically, as well as taking coconut oil and lecithin supplements. Today, mom is still experiencing significant burning nipple pain whenever she touches the nipple and  during the start of each feed. 

I'm feeling a bit stumped. Mom and I talked about doing an in-person follow up (all the help since Monday has been phone/e-mail) but I'm not sure where to go with this. Thank you in advance for any suggestions!

Kim Johnstone, IBCLC HHP

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