Hi all, Have a client that I would appreciate any input on due to confounding variables. G2P2, currently exclusively BF 8 wk old. 1st baby unsuccessful nursing due to ? latch problems. I did not know her then. Chief complaints - extremely sore rt nipple, very small (2 mm) cut or crack on nipple at the 1 o'clock position that opens with each nursing session. The cut has healed, gotten worse, on and off. Nipples pink but no itching, burning, other pain, no breast pain, no vaginitis, no thrush visible in baby's mouth, no recent abx. History: mastitis resolved treated with abx full course, followed by probable thrush, mom treated with nystatin cream x 10d and baby treated with nystatin susp x 10 days starting May 30, while using other anti-thrush measures. Symptoms resolved. Other current complaint - baby is miserable; fussy during feeds at 2nd breast, fussy, gassy, colicky after feeds. Burps poorly, passes lots of gas. On Mylicon (simethicone) drops and Levsin (hyoscyamine) syrup per pediatrician. Baby 10 lbs, 2 oz at birth, at 2 wks wt about 13 lbs, now at 8 wks about 17 lbs. Has red, dry rash on face, neck, back and ears dry and flaky, on special shampoo (? name) and cortisone cream per pedi. Stools yellow, normal about every other day. No supplements ever, no solids ever. Pertinent facts: mom loves dairy, consumed tons during pregnancy, and loves milk, yogurt, cheese, ice cream. Tried no dairy x 6 days with no improvement, but did not read labels, etc. Maternal aunt with milk allergy. Mom stops baby after 15 min on 1st breast and about 20 min on second. I can't remember everything as I don't have chart here at home. My differential diagnoses are: 1. milk allergy -- recommended dairy free x 21 days and gave lots of info on this 2. oversupply/overactive letdown -- didn't really fit the picture of maternal symptoms (no leaking alot, no spraying, only 1 prev. mastitis) and no green, explosive stools, etc; however does have great wt gain, and is maybe clamping down on rt nipple. Mom feels rt side is fuller but does not notice any forceful letdowns, etc. I did recommend finish 1st breast 1st. Nipples misshapen after feeds with diagonal stripe (uses cradle hold). Deep latch, no tongue tie, somewhat "chewing" motion with digital exam. 3. persistant thrush 4. combination of any and all above. Laurie Wheeler, RN, MN, IBCLC Violet Louisiana, USA mailto:[log in to unmask] _____________________________________________________________________ You don't need to buy Internet access to use free Internet e-mail. Get completely free e-mail from Juno at http://www.juno.com Or call Juno at (800) 654-JUNO [654-5866]