Hi all!  PTP. Saw a mom today who is nursing baby #2. Baby is 7 weeks old and she is on her 3rd bout of mastitis. She also said she had mastitis "everyone other month"  with her first child, (now 2 y/o) who weaned at 15 months. Mastitis is bilateral, comes on with very little warning, has occurred in all four quadrants randomly, and has not responded to antibiotic treatment. Her baby is gaining above average (checked for lip & tongue ties, referring to our local preferred provider), infant has a high palate, shallow gag and pops on and off the breast. Mother has abundant milk, said she thought that her problems related to a forceful letdown, but during  our exam today we agreed that her letdown is normal. I referred her to her OB provider for a thorough exam as well. We worked on alternate positions, mother has become very proficient at hand expression and breast massage. . Her nipples are normal, with no blanching or compression after feeds. She said she has never had any nipple injury, even in the early days of breastfeeding.  She has history of irregular menses and ovarian cyst, per her prenatal chart "Her pregnancy was conceived normally. This pregnancy was planned. Vegetarian, does eat seafood."  She is an office manager, her husband is a veterinary technician. Prenatal labs Hgb and Hct slightly below normal.  Your guidance and wisdom would be greatly appreciated. Thanks!! Leslie

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