Lisa,
Steroid cream is used as an anti-inflammatory agent. Unless it has an antifungal added, it will decrease the inflammation and may feel better temporarily but does not address the yeast problem if in fact it is a yeast infection. Just curious does the baby have any symptoms orally or in the diaper area? Generally, the steroid cream isnot applied heavily and excess is rubbed off on nursing pad or bra. What about having her rinse nipples, then pat dry before she nurses/pumps? Is she nursing or pumping or both? How long has she had this problem? How old is the baby? What else has she tried? Does she have a history of chronic yeast infections? Just some thoughts/questions. Don't you wish we could exchange photos for times like these? Anybody out there, feel free to chime in.
Colleen McKeown RN, BSN, IBCLC
________________________________
From: lisa clements <[log in to unmask]>
To: [log in to unmask]
Sent: Sun, May 16, 2010 5:09:32 PM
Subject: Throwing away ebm after using steroid cream on breast
Hello there folks.
I have a client with excoriated breasts surrounding nipple and areola, both sides, pain upon feeding. I suggested thrush and she went to G.P. for prescription to treat same. G.P. thought it was dermatitis, and gave her steroid cream.
Client now states she is discarding ebm as baby might get some steroid from cream. I explained I considered this highly unlikely as the cream is only absobed locally, but said i would check in case there was some danger i am not aware of.
Any thoughts suggestions?
She now says the excoriation comes and goes. I think the redness looks very thrush like. Would a steroid cream knock thrush on the head at all so it would give some indication of appearing an effective treatment?
Thanks and look forward to your replies.
Lisa in Canberra . Australia
________________________________
From: Colleen McKeown <[log in to unmask]>
To: [log in to unmask]
Sent: Sat, 15 May, 2010 4:56:26 AM
Subject: Re: Intake with nipple shields
Dear Susan, Catherine and All,
I have attempted to reply to Susan's commentary for the past day and for some reason Lactnet would not allow me to. Therefore, I will attempt again...
I feel that I must reply to your message as I do not want my intentions, breastfeeding philosophy or statements misconstrued. When I wrote about pumping after feeds, I was referring to the mother who is in the early stages- days post delivery. However, the need for continued pumping may be warranted. When I suggest using or begin using a nipple shield in the early days( which I admitted is not something I like to do but sometimes as we all know too well, is at times unavoidable), it is because there is a problem. What I neglected to mention is the importance of checking the teat for colostrum and especially in this population of first time moms in the first few days post-delivery. We should not assume transfer of colostrum in this population. Further, the approach needs to be tailored to the individual circumstances of the mother and infant. I agree with the fact that pumping is exhausting but when faced with a sleepy, non latching or poorly
latching
infant, there is little argument that it is a reasonable alternative. Let me be clear that I am not advocating pumping after feeds for the duration or for the mother with a "copious" milk supply.
Generally with this type of volume, there is not a need to pump, ahh, but then again there are always exceptions right? So the copious producers were not the moms I was thinking of when I posted my comments, but the ones struggling with latch and frustrated were.
What is really important here is regular and continued follow-up of mom and baby to assess progress and detect problems. It is imperative in the ealy days when using a nipple shield ( and when not using it)that a number of assessments take place and some of these include, observing the infant's response, behavior's, color, voids, stools and degree of weight loss. I do not do milk transfers on a primip in the first 3 days because her volumes are typically low and this may sabotage her efforts. There are occasions however, when I do do milk transfers in the hospital with a new mom and baby and it really depends on the situation. Test weights upon her return after discharge and at subsequent consults are also performed. The mom must also be assessed for breast changes and lactogenesis. There are times too I agree that a nipple shield simply does not help a situation. It's important to recognize this.
It is not ever "cookie cutter" which for me is probably why I have loved lactation consulting so much for the past 21 years:) and enjoyed facillitating a weekly mother's support group until very recently for the past 11 years. This group was designed for moms and babies for the first year and was well attended. In this group I've had occassion to come across moms who just simply continue nursing with a shield. Gasp! In spite of being counseled to wean from it. They are admittedly in the minority and since milk supplies were excellent and babies were growing and developing well, I simply observed.
I couldn't agree more with the importance of and need for mentoring programs in lactation consulting. What we do comprises art, skill, healing, science and passion and I'm sure some other things too. Those of us on the front lines in the hospital are doing our best ( as I believe we all strive for) to provide an individualized approach in a safe manner and according to standards of care to our breastfeeding families.
Colleen McKeown RN,BSN,IBCLC
From: "Catherine Watson Genna, IBCLC" <[log in to unmask]>
To: [log in to unmask]
Sent: Fri, May 14, 2010 8:28:39 AM
Subject: Re: Intake with nipple shields
I agree with Susan Burger that we don't need to make blanket recommendations for pumping when mom uses a nipple shield, just like we don't want to make blanket recommendations about pretty much anything without a good assessment, and then we individualize our recommendations accordingly.
I too use test weights to confirm whether a baby does well with the shield or not, and I don't let moms keep the shield if it didn't work well. In my most impressive case, a baby with torticollis and a very asymmetrical mandible (it was at a 45 degree angle to the maxilla on the shorter side), the baby transferred 0 without the shield, and 3 oz (85 ml) from one breast with it! If we made that poor mom pump, she would have developed an oversupply.
Moms using nipple shields do require careful counseling. They need to know to watch baby's behavior and diaper output, and how to intervene quickly if baby needs more milk to avoid their milk production dropping. They can be taught to count stools and watch baby for excessive sleepiness or fussiness and start pumping and giving extra milk immediately, and come back in for a follow up as well, if they see adverse signs.
The big problem with the 'medicalization' of lactation consulting is that there is a push to 'protocolize' everything. Natural systems that involve two individuals have so many variables that this is difficult to counterproductive. While it is vital to understand the system design, function, and interactions, it's not possible to have a one size fits all solution for each potential problem. Just one more reason why it takes a long time to develop true expertise in this field, and why our mentoring programs are so valuable.
Catherine Watson Genna, BS, IBCLC NYC
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