The first thing I think of when I have a client with pain free nursing for a
while, then symptoms that you describe, would be thrush. (please note: I
rarely see or hear of a client w/ thrush). Mastitis "usually" presents
unilaterally, however thrush "usually" presents bilaterally. Of course,
allergic reaction or eczema type skin problems can occur too. The red
"breasts" don't really sound like thrush, but since you said she is pumping
but not really pumping often enough, I am thinking thrush plus
engorgement->milk stasis mastitis.
My plan would be to very effectively drain the breasts regularly (pump or
hand express), treat for thrush (make sure a full course of treatment), I
would recommend topical and systemic (Her dr. would have to prescribe), I
would recommend she see a dermatologist to be sure. Of course pain relief,
ibuprofen would be a good choice I think.

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

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