Jaye writes: "Approximately 10-20 minutes after the first feed that  pain 
starts in nipple
with burning sensation then progresses to excruciating,  shooting pain
(lightening bolt type) through center of breast sometimes  angling out to
underside of breast.  This pain lasts for 3-4  hours.'
 
These sx sound like intraductal yeast but I would expect sx to occur  
throughout the day, not just with the first feeding.  I am guessing  that since baby 
began solids and is older she is now going all night  without feeding and that 
the first feeding from each breast is after a prolonged  period without 
emptying.  I would have the mom try an experiment:  get  up after 3.5-4 hours and 
empty breasts, the goal being to not go longer than 3  or 4 hours without 
emptying.  If this alleviates the problem the pain is  probably due to refilling or 
some kind of spasms as the ducts are emptied.   She says breasts are not over 
full, but at 8 months she is probably not  experiencing the same sensations 
of overfullness that she did early on.
 
 
Jaye also describes that "Nipples are more pink than areola - one nipple  
looks almost purple - BOTH have little white dots on the face of the nipple (one  
more so than the
other) - the white dots look like they are under the surface  of the skin
with a pink haze over them."
 
I have seen nipples that are pretty pink with almost a line of demarcation  
and areolae are not--these moms have excema  (you state this mother  does have 
excema).  A trip to the dermatologist could be in order.   I'm not sure about 
the little white dots and the purple nipple.  She also  may be reacting to 
food left in baby's mouth when he starts nursing.

And,  of course,  mother COULD have intraductal yeast which would need tx  
with diflucan, but I would expect the pain to occur at times other than the  
first feeding on the breast.
 
Finally, I'd have mom look at the nipple for a few minutes the minute  the 
pain starts to see if there is any blanching, etc.
 
Let us know how this turns out.  She may have a mixed bag of things  going on.
 
Kathy Boggs, RN, IBCLC
Mountain View, CA

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