I had a question on the telephone today from a client I helped with her
first baby.  I have not seen her with the second baby who is spitting up
blood.

Mother had sore nipples the first four weeks, but no open cracks or nipple
trauma.  In the fifth week, she became more comfortable, but the baby began
spitting up blood-tinged milk.  It rapidly progressed to spitting up
everything, everytime she nursed him and he began passing tarry stools as
well.

He was admitted to ICU and given a full work up, but nothing abnormal was
found.  During his hospital stay, mother pumped and he was bottle fed her
milk.  There was no sign of blood in the pumped milk.

She went to her OB for her 6 week check up and her breasts were examined;
nothing remarkable was found.

She has continued for another two weeks at home, pumping and bottle feeding
her milk.  No spitting up, no bleeding, no nipple trauma.  A few days ago,
the ped. gave her permission to begin breastfeeding again.  After a few
days, she has a small crack (<1/4 inch), no pain, no blood on her bra pad.
But her baby has again started spitting up and there is blood visible in the
emesis.  This is not just pink milk, but red clumps.

Has anyone else seen this type of situation before?  Her ped is mystified.
Is it likely that there is a small capillary that is opening up whenever
baby suckles?  He does not tolerate the blood in the milk and spits up
everytime.  Mother reports that he has a very strong suck, more so than her
first child.

We talked about pumping the side with the crack while that heals.  She will
try a nipple shield on the other side when she breastfeeds to see if that
makes a difference.  Other suggestions/observations would be appreciated.

Diane E. Perrone, RNC
Materna Wellborn
Algonquin  IL   US                    Go BEARS!

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