Cindi
The first thing I would think of with the presentation you gave would be
yeast. It sounds like a pretty classic presentation of new nipple pain after
a period of pain-free feeding (3 wks), pain inside the breast and radiating
to the back. Even though the mom/baby did not have the predisposing
condition of abx use, it could still be yeast. Sometimes it is a muscle or
nerve pain due to positioning issues or even a poor latch with clenching
type suck. I usually ask the mother if she is noticing any vaginal yeast
symptoms, if the baby has *any* patches on the mouth area, if the baby has
any diaper rash symptoms. Sometimes this reveals some yeast evidence. Does
she notice any difference in the appearance of her nipple/areola skin, often
it is red, pink, shiny, inflamed looking. Anyway, I would proceed from this
standpoint first, unless I could uncover anything else in a more thorough
history taking.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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