Hi Christine,
How do the nipples look? If there is a definite rash I would be thinking of
eczema / dermatitis. Are the nipples painful all the time, just on latching,
for the whole feed? If painful all the time, I would be thinking of thrush. How
"sore" are they? I use a scale of 0 = no pain and 10 = the worst pain you've
ever had. I realise in this case, the mother is a friend rather than a client,
so it's harder to ask all the questions.
In medicine, we say that most (?90%) of diagnoses can be made on the history
(ie asking the right questions). At work this week I have seen 2 women
"labelled" as having thrush for weeks - but when I asked about the pain, it
only occurs every couple of days and is very mild! OK maybe they still have
thrush, but they do not need to be obsessively doing the whole gamut of
treatment that someone who has a 8/10 pain all day will be doing.
Lisa Amir
GP /IBCLC in Melbourne, Australia - where it's a perfect Autumn day.