I want to pick the collective brain about a gal that has us stumped.

She is a primip in her early 20's-single mom.  Saw her at 4 days with poor
latch and sore nipples.  Corrected latch and did well.  Called 10 days later
with sore nipples--was seen again, with beautiful latch and nothing visible
on nipples.  Baby has a slightly high palate, normal tongue.  Mom noted to
have a slightly flat affect.

We called her a week later when we hadn't heard from her, at which time she
said "My boobs are so sore-it hurts to nurse or pump".  No redness, no other
mastitis symptoms.  Saw her again-no visible abnormalities.  Pain reported
over entire Left breast, and parts of Right breast.  Did not initially
describe deep pain as "shooting", but said it was when asked.  Tried a
loading dose and 5 days of Diflucan with no change in pain.  600 mg Ibuprofen
did not help the pain. Today she reports the skin of her breasts itches, but
there is no rash or redness.  Both breasts are still sore and ache. Has
started to give some formula--pumping and bottle-feeding.  Not nursing
because now feels it hurts worse than pumping.

My gut feeling is that she wants to wean, but won't admit it to me (or
herself?)  Should I ask her about sexual abuse?  Should I suggest she may be
depressed?  Should I stop calling her so she can go ahead and wean??  Is
there anything that rings a bell for anyone in this story that I am missing?

Thanks-

Kathy Leeper, MD, IBCLC
Medical Director
MilkWorks
A non-profit Corporation providing breastfeeding education, consultation,
support and related supplies in Lincoln, NE (Now nearly 5 months old!)

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