Ellen, the pediatrician probably doesn't want to treat for thrush because
when there is no clinical evidence that the baby has it, it is imprudent to
treat for it.  It makes no sense to treat a baby when  there are no
symptoms.  Our profession has made itself ridiculous on this issue of trying
to convince the doctors we work with that every case of sore nipples is
related to this mystical, invisible fungus that supposedly resists all this
aggressive, irritating and time consuming treatment we recommend.  Not every
case of sore nipples is caused by thrush.  In fact, as time goes by, I am
more and more convinced that nipple candida is fairly uncommon.  Not that it
doesn't exist, but I feel quite certain it doesn't exist anywhere near the
extent to which we have become convinced it does.

I'm glad the Pediatrics article (current issue) talks about Reynauds as a
cause of sore nipples, and mentions specifically that this often gets
"diagnosed" as candida.

In the case of Ellen's mom where the dermatologist dx irritation and
recommended lubricants, yes, this is probably exactly the problem.  The sore
nipples should resolve with reduction of the inflammation with brief steroid
use, or just some barrier moisturizers.  The mom may need to lubricate her
pump flange well and let the nipples calm down for a few days, but why she
would have to pump and dump or wean is beyond me.  Look up the meds in Hale,
but check the spelling.  I can't locate Aclovate in the 2002 edition.
.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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