HI All,

 

I saw the mom with the 8 month old today.  To recap - 2 months ago she began
experiencing shooting pain through the breast after the first feeding of the
day.  She has a history of yeast, eczema and latch issues.   She also told
me of little white dots on each nipple.

 

I suspected thrush.she will be getting cultured on Friday (4-28) for yeast.


 

I saw her today and watched a feeding.  She was latching this boy as if her
were a newborn - but I could see why.  Her positioning wasn't the best - she
uses a Boppy at home (part of the initial problem maybe??).  At 8 mo baby is
wiggly but loves to nurse.  His latch is shallow and there is a LOT of <in
and out> breast movement when he sucks.  He also has a high palate is fairly
high tone.  He is very tight in neck, back, all over - also his head is
lopsided.  I made a referral to a CNMT (neuromuscular therapist) as well as
a Bowen Therapist to work with the body issues - both are highly skilled
with babies.  We adjusted her latching technique and managed a much deeper
latch where there was little to no breast movement at all.  Mom could see
and feel the difference - she now knows what to watch for.  

 

There were NO signs of thrush in baby at all.  Mom's nipples are pink, and
the white dots look like possible blebs - but I am not entirely sure.  I
have 2 pictures if anyone would care to take a look and give me some input.
I have a signed consent form from mom.  She is eager to resolve this problem
ASAP.  The nipple did look a tad squished when baby came off with the
shallower latch - but was fine with the one really deep latch he got.  

 

My thoughts and what I discussed with mom are:  I believe that there may be
2 issues going on - possible thrush for mom with baby asymptomatic.
However, more likely is long term trauma and resulting nerve pain in the
breasts as a result (but why only the first feed of the day?).  So now what?
Nothing she has done so far (ibuprofen, heat, cold) has worked to alleviate
the pain in the morning.  Would body work for her help??  If so, what part
of her body do we work on?  Will better latching help, over time, to
permanently resolve this issue?  I suggested that, after the culture, to
start APNO and continue to work on the positioning - be vigilant!  What
about the potential blebs?  The are not raised when baby comes off the
breast and do not cause mom pain - they are just 'there".  We watched for
signs of vasospasms occurring - but there was no blanching at all.  Mom
reported that there has never been a color change when the pain was
occurring.

 

Thoughts?  Ideas?  Anyone willing to take a look at the photos and tell me
what you think?

 

Thanks in advance!

Jaye Simpson, IBCLC, CIIM

 


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