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Date: | Sun, 6 Mar 2005 16:56:28 -0500 |
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Lynn,
Welcome to private practice! There are very few straightforward
situations for us PPLCs.
It sounds like this baby is not efficient enough to sufficiently soften
this mom's breasts. I generally like to see a much more vigorous weight
gain, especially if the baby is catching up from a significant loss or
initial failure to gain. Is mom pumping? I would want her to pump after
every feeding to help increase supply with a baby who was below birth
weight at 2 weeks, and I would check out baby's sucking skills and oral
anatomy to make sure that was not the reason for the lousy intake, in
addition to the lousy latch.
Sometimes lecithin works for recurrent plugs, and a mass that does not
change after a few days of good management deserves to be checked out by
a physician. I've had several moms get needle aspiration for abscess,
for one it was done repeatedly, and was curative. Ultrasound was not
needed, as the abscess was close to the surface and readily palpable. A
recent mom had 2 abcesses back to back (one in each breast, from really
atrocious full thickness nipple wounds) and just couldn't face
breastfeeding anymore. I referred her to a physician for treatment of
the infection, and advised her to pump to softness until the abcesses
were healed, and then we reduced the milk supply slowly by alternately
reducing pumping time by 1 -2 mins per session and going an extra half
hour between pumpings until she was comfortable stopping. I hope you
have a really good breast surgeon to refer her to for help.
Catherine Watson Genna, IBCLC NYC
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