Theresa Moutafis,
1) I think you are on the right track in considering a pump injury. The
time frame in the history you described, as well as symptoms, suggest this
as a possibility. If you are using a video link for the tele-health, the
mother can of course show you the pump in action, but if you are using
voice over telephone consider whether she can text you a video clip or
photos. Does she have information on hand expression, ideally with a link
to a video?

2) Another possibility would be nipple dermatitis, perhaps from topical
applications to the area or residue if the pump flange is being sanitised
in a chemical solution (or even with hand sanitiser). If contact
dermatitis, your client's medical provider may wish to prescribe a topical
hydrocortisone ointment for short-term use (Hale & Row, 2017, pp. 465-466).

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Private Practice IBCLC Lactation Consultant,
Historian of Medicine.
Ipswich, Queensland, Australia

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