I would appreciate your insights with a mother I saw some time back who is still having problems. It's a complicated case, and I won't take the time to provide all the details here. I originally saw the mom for pain with feeding (which seemed to be improved with better latch) and low supply (which improved slightly but never caught up despite mother's use of herbal galactagogues and domperidone, frequent feeding and pumping, etc.) Baby was also treated for posterior tongue tie, which made only small improvements in latch. I saw mother for a follow-up visit and baby latched well, wide gape, mother reported pain during feed, but there was no nipple compression after feed. The mother's nipples and part of the areola were noticeably red. Baby also made strange breathing sounds during swallowing (but not stridor). Baby sometimes leaks milk at the breast and often with a bottle. I suggested mother see a dermatologist, but the doctor she saw said the nipples looked normal to her (!?). Mother's pain with feeding increased, and I reviewed treatment options for thrush; mother and doctor chose to treat with diflucan. Original dosing was not optimal, but mother went back to doctor and got appropriate dosing. She did one course (loading dose, two weeks at 200mg/day, then four weeks of a once weekly dose of 200mg) and was pain-free in a few days. However, the pain returned when she went to the weekly dose. Another doctor at the practice then prescribed 200 mg/day for four weeks (not sure if there was a loading dose again). Mother again felt better quickly. Through this time the nipples remain very red. Any suggestions for what might be going on? Why would pain improve with diflucan, but redness remain? What else might it be? Should she try to see another dermatologist? Lisa Mandell, MBA, IBCLC Havertown, PA USA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome