Hi all,
Permission to Post:
I looked in the archives and found some excellent information posted about recurrent mastitis but need a few more answers from this outstanding group of professionals for this mother-baby dyad.
Baby girl born 11/10/10 (almost 11 weeks old), posterior (Type lll) tongue tie, frenulectomy done 1/7/11 but tongue is still not lifting well.
Has been underweight for most of her life, weight fluctuates upwards when mother does breast massage prior to feeding, breast compression and works hard at nursing her, and dips when baby is left to her own power.
Sister age 2.5 years who was breastfed until 2 years.
Mother, has sore nipples with vasospasm, hyperlactation, multiple bouts with plugged ducts bilaterally, leading to mastitis 2 times in past month.  Treated with Dicloxacillin the first time, now 6 days into Clindamycin therapy with some improvement but still has full, tender ducts and some mild achyness and headache.  Has had several sessions with a physical therapist who has used ultrasound on her breasts and did specific massage to remove plugged ducts, which works sporadically.  Has used sage tea which is working but slowly.  She has also started taking lecithin 2 weeks ago 1000mg daily.  I have suggested a few days of pseudoephedrine 60mg BID to bring her supply down.
Mother also has history of MRSA skin infection and was told she was a carrier.  She is also allergic to sulfa drugs so if this is MRSA, I believe our only option is to use vancomycin, which is given IV (oral vancomycin remains in the GI tract and is not absorbed, which makes it good for intestinal infections but bad for other parts of the body.)
My thoughts are to get an ultrasound to see what is happening in the breasts, although there are no obvious abscess signs, and a culture of her milk.  I have a call into the local breast surgeon too.
I have also sent the baby back to the ENT for re-evaluation of her tongue and potentially repeat frenulectomy...and perhaps some cranio-sacral therapy.
Any thoughts?
Annie Brown, FNP, IBCLC
Greenwich, CT
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