I have been working with a patient that reports having bleeding from her
nipples prenatally and increased after delivery.  Her 4day old was
readmitted to hospital with dehydration and Na of 155.  The baby would only
suck a few minutes then cry and push away from the breast.  She had not
been pumping her breasts until baby hospitalized.  Was able to express
about 40 cc from each side simultaneously.  No sore nipples or other
symptoms.  Could not get baby to nurse but 10 min on one side while I
evaluated her.  Suggested giving EBM with syringe or cup after attempting
to breast feed 1st.  Told her not to force breast fdg as perhaps baby
associating BF with something unpleasant.  Do you think the refusal is
related to the large amt of blood in the milk?  She has history of
papilloma virus 2 years ago.  Could the bleeding be from papilloma in the
milk ducts? If so, how is diagnosis made?  Her OB said the bleeding is
unexplained and she has never seen this before, but did not suggest
mammogram or ultrasound. Any ideas?