Dear Wise Ones-
     I have been working with a mom who called me because of a sore nipple.
Her baby is four weeks old and one nipple has been painful since day 3 or 4.
SHe has discomfort while breastfeeding, and SEVERE pain after breastfeeding.
Ususally, when I see pain after breastfeeding like this, it is nerve pain
following the nipple being pinched, and sometimes a Raynaud type phenomenon.
However, this mother has no blanching after nursing, no rebound hyperemia, no
ridge or compression stripe.  No cracks, no blisters, no bruising.  Skin
integrity is good.  Her latch is good, positioning good.  She took a couple of
days off from nursing on that side and pumped.  No pain from pumping.  After
several breastfeeds, pain returned with a vengence.
     Thrush?  I don't think so.  Mom has NEVER had a yeast infection, neither
mom nor baby has been on antibiotics, baby has no diaper rash, no visible oral
yeastie patches, no leaking of breast milk with wet pads against the skin.
     Milk supply is slightly greater on painful side.  In case baby is
compressing breast or pulling back to slow/cope with flow, mom is nursing with
baby prone or upright, making extra sure that lips stay flanged, latch deep.
     Any other thoughts?  Please e-mail privately as well as to the list.
Thanks!
-Debi Page Ferrarello, RN, IBCLC
stumped in Abington, PA