I have permission to post from this mom.

Baby is 4 weeks.  I saw mother-baby early on when she was dealing with
difficult latch due to engorgement as well as weight gain issues.  Those
resolved fairly well, although the weight gain is still a puzzle.

I saw her yesterday c/o persistent nipple and breast pain in her left
breast.  It was one of those times I wish I could have seen what was going
on in the baby's mouth because everything "looked good" from the outside.

Here's the basics:
Mother c/o persistent pain, in nipple and in breast, with every suck.  Pain
is described as stinging, throbbing.
Baby observed to take in all nipple and much of areola (mother has rather
small areola) in what looked to be deep, asymmetrical latch.  Baby latched
so nicely and easily, I was surprised when mother winced.
Mother seated comfortably.
Mother c/o pain in nipple and breast on pumping, same as at breast.
Mother saw ped. who saw no signs of yeast in baby.
We interrupted the feed and I had baby suck on my finger.  Palate seemed
WNL, tongue cupped my finger, no gumming.  No clear tongue-tie although she
was not amused when I probed beneath her tongue.  She quickly
became impatient with suckling when there was no milk flow.
We tried breast compressions to see if increased flow would affect baby's
suck, decrease pain; no apparent impact on baby's suck, *increased* pain.
When baby came off the breast, nipple was not mis-shaped.  There was what
looked like a very tiny blood blister on the very tip of the nipple.
Possibly a little blanching.
The breast that is painful is the same one that produces the most milk.
Baby took 72cc at feed.  Baby gained 3 ounces in a week when exclusively
breastfeeding --but baby only feeds 7 times per day.  When parents resumed
supplementing, baby then gained 16 ounces in one week (I know, excessive
supplementation).  I think baby could gain adequately at the breast but pain
is a barrier to mother wanting to breastfeed and/or pump more frequently.

My thoughts:
Although no signs of yeast in baby, possibly yeast in mother.
What's up with seems to be persistent "ductal" pain?
Reynaud's?

Your thoughts are appreciated.

Mary Wagner-Davis, MS, IBCLC

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