Hi All,



I got a call this morning from a mom with an 8 month old little boy.  This
will be a bit long with history - but I need help in order to determine what
is going on with her - I have my suspicions but need some clarification and
want to make sure I asked all the questions.



Baby born 8/17/05  BW of 8' 11" - full term.  Vaginal delivery - no
antibiotics - 4-6 hr epidural - no vacuum or forceps used.  Had latch issues
- cracking, bleeding - all LC stuff over phone - no one suggested an in
person consult (don't get me started.).  4 weeks of this and mom and baby
worked it out and things went well for the most part.  Occasionally there
would be a couple days of poor latching for unknown reasons - one or both
nipples would get sore - then it would work itself out and things would be
fine for a few weeks until it happened again.



Baby started solids at 5.5 mo of age.  At 6 months mom started having severe
pain after the first feed on each breast.  Baby takes one breast per feed.
Pain goes as follows:



Approximately 10-20 minutes after the first feed that pain starts in nipple
with burning sensation then progresses to excruciating, shooting pain
(lightening bolt type) through center of breast sometimes angling out to
underside of breast.  This pain lasts for 3-4 hours.  Mom has tried:
Ibuprofin, ice packs (Primary care Dr told her to stop that bc it could dry
up milk supply) Dr gave scrip of Keflex for assumed infection - no diagnosis
- , has tried warm packs, shower - Nothing helps.  This has occurred every
day for the past 2 months.  Dr. wants mom to wean - NOW - mom has said NO
and refuses to wean.



I have asked mom to pay close attention to nipples when this happens to rule
out Reynaud's - I don't think it is this anyway.but let's look at it all.
Breasts are not overly full in the morning - she did have the rapid
refilling scenario early on - but she reports that this feels quite
different from what she experienced with the rapid refilling.



Mom has history of eczema - is on complete dairy free diet due to baby's
allergy.



Mom was using Lansinoh daily in hope that would help - I advised to stop
that now so we can take all potential cuases out of scenario and start with
a blank slate.



Mom has history of vaginal yeast infections - 1-2 per year with last one
being 1 yr before birth of baby.



Baby has no signs of yeast per Ped 2 wks ago.



Mom's Dr says nipples look fine:  HOWEVER:  Mom reports the following:



Nipples are more pink than areola - one nipple looks almost purple - BOTH
have little white dots on the face of the nipple (one more so than the
other) - the white dots look like they are under the surface of the skin
with a pink haze over them.



Nipples are somewhat tender through the day - but do not burn or itch.



Am I missing anything?  What other questions should I be asking?



My thoughts:  I suspect intraductal yeast as well as external.  I think that
this is an on-going minimal-symptom kind of thing - comes and goes but is
now getting progressively worse.  I have not seen mom in person yet - I
suggested she come over so I could take look, maybe take a picture of these
white dots with the pink haze.  She is amenable to that.



So - Thoughts?  Ideas?  Input is greatly appreciated.  Her NP called me this
morning asking for input so I will be following up with her as well.



Thanks in advance.



Jaye Simpson, IBCLC, CIIM




















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