I don't know if I need reassurance or if I need to be corrected.... ( ha ha
)  Please tell me your opinions...:
A client comes to our breastfeeding support group yesterday with the
following symptoms:  Infant is 4 weeks old, was tongue tie, got clipped at 6
days of age. Mom's nipple pain ceased after the clip, and within a few days
even the soreness resolved completely.  Now has a lot of "electrical" type
pain in breasts, feels like razors when infant latches. "just hurts" .  Her
nipples are bright pink and slightly glossy, with one having a paper cut
like crack around a portion of the base.  Over the past few days baby has
become very fussy at the breast, most notably at the beginning of the
feeding.  Infant has also started nursing for shorter periods of time but
more frequently.  Is more fussy than usual and has started spitting up.  On
exam the infant has no signs of thrush on the inside cheeks or under tongue
but does have a slightly thicker coating of white on the tongue which does
not wipe off with a swipe of a covered finger.

Mom has a great supply but has noticed that since infant is fussy and
shortens the feedings that she feels fuller prior to feedings and not as
emptied after.  She already leans back when nursing if she feels more full
and has baby's bottom lowered to help with SMER.  This worked well for her
until a few days ago.

So I felt that she probably had yeast and baby has thrush. I suggest a visit
to pediatrician for baby and for her to contact her OB for treatment.  I
tell her all the options for treatment for both and advise her that her
symptoms suggest ductal yeast and yeast on the nipple/areola. I tell her mom
and baby should both be treated and that even if one did not have symptoms,
if either of them have yeast, it is recommended that they both get treated
at the same time for at least 2 weeks.    I give her several sheets on
treating yeast, diet, cleaning, for reference etc.

Her pediatrician told her the baby did not have thrush and it is not
recommended to treat the baby for something that they do not have. The ped
also told her that it is not recommended to take Echinacea and that she read
that in a recent study.   Her OB doctor told her that they would prescribe
Nystatin ointment for her nipples but that there was no reason to "pull out
the big guns" (meaning Diflucan) until they have tried other treatments.

Now I sound like some kind of a nut case to mom... I can't believe she even
called me back this morning to get more advise.  I did suggest she ask her
OB if it is alright that she take Grapefruit Seed Extract and I told her to
be certain and contact both doctors if her symptoms or baby's get worse.  I
read to her information on symptoms from Dr. Newman and also from
Riordan(3rd edition).  She said, "Well we already have all those."  I
encouraged her to contact he doctors if these symptoms get more severe.

Am I a nut case?...ok, maybe I am but, am I incorrect in my judgment and
recommendations to her?


Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager

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