I saw a mom yesterday whose case is not clear-cut. She had latch problems
from birth, had cracked and bleeding nipples early on, and has experienced
shooting pains (sometimes burning) that occur at various times, not
necessarily directly related to nursing. The pains are worse in the breast
that baby has had more problems with. Mom says that her nipples are sore,
but they are mostly healed compared to the beginning, with one being pink on
the nipple only, and the other with a small "cut" in it.
Baby was 5# at birth, now 5#14 at 3.5 weeks; her weight hx shows that she
started gaining well but has slowed down a bit, gaining 2.5oz between 2 and
3 weeks and 2oz the last 4 days. Baby was actually late for dates, so I'm
not sure if she is SGA. I did think that she looked a little unusual at
first glance, almost reminiscent of Downs. I also saw her do something that
seemed unusual: she was awake but keeping her eyes half-shut, and rather
frequently I saw her eyes roll back to the whites only through the slits.
This occurred for a couple of minutes during one of the times I held her,
and did not repeat.
Her suck assessment was pretty decent; no excessive suction, good initial
seal and cupping, decent peristalsis, no clamping or biting down. She does
"mix things up" a bit, however; periodically I would feel the middle of the
tongue sort of raise up and move around, breaking suck rhythm in a manner
that would probably slide down on or kick out a breast. At breast she does
not automatically latch deeply, and given what I felt, she probably starts
off right but then ends up pushing the breast out a bit shortly into the
feed. Mom's nipple generally comes out flattened and a bit white-- so there
are definitely some mechanical issues here.
Mom had one vag yeast infection during pregnancy which seemed to completely
clear before delivery. Mom has no signs of vag yeast now, and baby's tongue
and diaper area are clear. She has had lots of back problems and is
currently in the care of a chiropractor, and she also told me that she has
had neuralgia, not as an official dx, but as descriptive of other shooting
pains along nerves that she has experienced in the past. She has also done
some leaning over to help baby latch on difficult breast. In addition, there
is a big hx of allergies for mom and her family; much airborne and also
several foods, which she avoids. (could baby be itching palate?)
I see four possibilities for the shooting pains themselves:
-Yeast
-Nerve irritation due to nipple trauma
-Referred pain from poor posture or the other back problems during
breastfeeding
-An extension of the neuralgia she already suffers from, possibly
exacerbated by any of the above.
We worked diligently on positioning, of course, and I've added a little suck
training before feeds to reinforce the tongue staying down and not moving
around. She will be trying an anti-fungal cream on her nipples to see if
that helps any. I have asked her to let her chiro know about the shooting
pains. Am not addressing allergies at this time.
What I'd like to know from you all is:
1) What do you know about neuralgia? Is there an underlying cause, or is
this sort of like fibroneuralgia? Are there any normal treatments or comfort
measures that might possibly help this mother?
2) What are your thoughts about baby physically?
It is quite likely that we have a combination of things going on, and I want
to be thorough.
Thanks,
Lisa Marasco, BA, IBCLC
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