Hello all, I am posting to see if any of you can offer me any
assistance with a problem that has me puzzled. Patient has given me
permission to post about this.
History : Moms second baby , breastfed the first one for well over a
year without any problems. Well educated black mom , husband supportive,
delivered an 8 pound boy on Septem 26 . Weight almost 15 pounds now.
I have spoken to this mom several times on the phone during the last
three months for c/o sore nipples. Mom has been reluctant to come in
until today. Baby dx with thrush about 6 weeks ago, mom tx baby with
Nystatin , no improvement in her nipples , when I spoke to mom i told
her that she had to treat herself as well and mailed he Kay Hoovers
thrush handout with instructions. At this time mom was having some itchy
nipples and some burning pain in breasts. Mom treated herself with
vaginal yeast cream on her nipples a few times per day for 10 days but
didn't retreat baby as I had recommended at that time.
Mom is a very natural person, takes herbs, but none at this time. Mom is
on no meds at this time. Had a clogged milk duct at 6 weeks which
resolved with heat and massage and freq. nursing. Mom has c/o sore
nipples since baby was a few days old. She states they have never been
not sore.
Mom presents today with crescent shaped abrasions on top and bottom of
the right nipple, very raw pink/red skin showing where the nipple meets
the aerola. The left breast had the same on the bottom, but not quite as
bad and above the nipple on the aerola a small, 1 cm spot of slightly
purple tissue. Baby has had no bottles, although mom has tried a few
times and he refused, and no pacifiers. Mom is not pumping, tried a
manual pump one time. Observed baby nursing in the cradle hold on the
right breast today. Baby's face was directly facing the breast, but his
body was rolled away. I corrected this. His lips were flanged and mouth
open wide, could pull down the bottom lip and see that his tongue was
troughed. Baby made gulping sounds while drinking and some clicking
sounds while nursing, baby appeared to have a correct latch on and
babies gums did not seem to be rubbing moms nipples. Baby would not
cooperate very well with a digital suck exam, mom says he only wants the
"real thing". The few sucks I did get out of him, were normal. Mom says
he pulls off a lot and looks around and she has to relatch him. I saw
him do this while he was in my office as well.
Mom states that she dreads nursing him due to the pain but she will not
consider giving up, (Not that I would suggest that) ;-)
I am not sure what is going on with her..... I didn't suggest shells
because she long since quit wearing a bra due to her nipples sticking to
it and hurting.
I recommended air dry after each feeding , apply lanolin after each
feeding , make sure baby is latched on and positioned correctly each
time and the she varies positions each time, warm soaks to the nipples
three times a day , until I could get some help from you wiser
ones.......
I was thinking could this be still caused by yeast even though she no
longer has true yeast symptoms and baby's mouth looks clear????
If anyone has any thoughts or ideas on this , this mother and I would
both greatly appreciate it!! Thanks!!
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Cindy , RN, IBCLC ***** Virginia , USA
mailto:[log in to unmask]
http://www.erols.com/cindyrn
ICQ # 412812
"Never doubt that a small group of thoughtful committed people can
change the world.
Indeed it is the only thing that ever has." - Margaret Mead
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