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Subject:
From:
PHYLLIS M KOMBOL <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 7 Jan 1996 04:18:18 EST
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Have had contact with a mom by phone
and will see Monday...need to see if I'm
forgetting anything:
Baby was 4 weeks early and is now 4
weeks old.  Had suck problems early
on and tore up mom's L nipple esp. badly.
Mom states "it cracked wide open."  Has breastfed
2 other children without problems.

Mom reports that baby now sucks good and
eats all feeds from breasts but has been unable to
get crack to heal.  Describes the crack as between
the tip of nipple and nipple-areolar junction on medial
aspect of L breast; crack .25" wide and .5"long, has
large nipples, H cup breasts.  Was on Keflex x 10 days for
mastitis in the first couple weeks, now following that
with a course of dicloxicillin.  Has had bilat yeast
(not sure if that started before or after the mastitis)
that she thinks started from over generous use of
lanolin.

Since last week as been treating with Lotrimin
cream 3 times/day...since no healing, got a good
hospital-grade pump to try pumping but finds that
whether she pumps or feeds baby, it reopens each
time.  Describes pain on latch as the crack breaks
open, then no further pain while he feeds.  NO sign
of thrush in babe but mom still has some sharp pains
in breast during feeding which is partly why (I think)
she was on second course of antibiotic.

We discussed whether she felt she needed oversize
pump shield...she really didn't think that was the
problem.  I think thrush is still an active problem.
Discussed changing to Lotrimin solution
rather than cream so it wouldn't need to be washed away
before next feeding, and rinsing nipples in clear water
after every feeding and applying Lotrimin after every
feeding.  Also discussed care of bras and pump
funnels re thrush...talked about airing nipples, but
she said at her size, when she goes without a bra
the weight of breast breasks the crack open, too.

She seemed more willing to feed baby than pump
since both seemed to open the crack equally with each
session.  Doesn't seem to be causing baby any trouble.
Crack doesn't bleed or anything, just open...stings when
she puts the solution on.  I'll be curious to see what it
looks like when she comes to clinic Mon....anyone with
suggestions for us?

I'm esp. curious because last week I worked with another
mom with long-standing cracks...I couldn't come up
with anything but thrush as a possible cause.  Watched
her feed and all looked ok.   Just these big damp cracks
that opened with every feeding.  Baby is 6 weeks old &
mom came for a pump to get ready to go back to work
& asked "Oh by the way....."

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