I have a client whose baby is 9 months old.  Breastfeeding was going fine
until about 2 weeks ago, when baby clamped down on the right nipple.  This
was followed by a plugged nipple pore and milk duct, which were resolved by
removing the pore covering with a sterile needle and compressing the breast
when baby fed.

But the nipple stayed sore.  Then, yesterday a reddened area appeared on
the nipple, sort of like one of the "usual" lumps on a nipple was red.
This is when she called me for the first time.

Today she began having radiating pain in her breast for up to an hour after
feeding. There is no tenderness in the breast with compressing.

I don't believe that it is yeast, even though some of the symptoms sound
like it. I suggested Jack's APNO and she is using it.  The nipple is
feeling better, but she still has the breast pain. The area that was red
seems to be bigger and "hard."

I suggested ibuprofen for the pain and that she continue the APNO for a
couple more days.  If there is no resolution she is to see a dermatologist.

Some other information:  Baby began 2 weeks ago to really get into solids.
He has been sleeping long stretches at night for a long time.  Mom began
craving chocolate and was eating it all day long.  Baby began to have colic
symptoms in the evening and into the night. Mom concluded herself that the
chocolate needs to be eliminated. He had a better night last night after
Mom had no chocolate for 36 hours.

One thing, that I thought, of is that with baby eating a lot of solids and
taking less breastmilk, mom may be preparing to menstruate--hence a craving
for chocolate and, in my experience, a possible decrease in her milk
supply. This could have been the cause of the initial clamping down on the
nipple.

So, along with ibuprofen and the APNO, I recommended a calcium/magnesium
supplement to help with the premenstrual drop in milk.  Today she said that
her breasts are fuller.

I am hoping that this case sounds familiar to some of you.  I haven't seen
anything just like this.

Pat Gima, IBCLC
Milwaukee, Wisconsin

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