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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