Get a culture. Had a mom with this type of thing - turned out to be
MRSA>
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Fogelmans
Sent: Monday, December 31, 2007 8:08 AM
Subject: pain where baby's upper lip touches breast
Dear Friends,
Please help. Mom gave me permission to post.
I first saw mom and baby when the baby was 6 days old. The mother was
complaining about pain during breastfeeding, particulary on one breast.
Pregnancy and labor were uneventful and without pain medications. Baby
roomed in in the hospital and baby only breastfed. We worked on
positioning, baby latched deeply and then would back off and on to the
nipple. I noticed that the baby's face was assymetrical. The doctors
had told the parents that it would straighten out with time but I
thought it was affecting the breastfeeding and suggested CST. Moms milk
dripped all the time. Baby gained 380 grams that week.
Mom went to 3 sessions of CST with a practitioner that I refer to often.
After the third time the practitioner said that the baby was fine and
there was no reason to continue. Mom said that she felt that the baby
was latching better.
At 3 weeks old mom called reporting thrush like symtoms. She went to
her obgyn who diagnossed thrush and started her on fluconazale
(diflucan) but at a very low dose. The mom then went to a dermatologist
who upped her dosage of fluconazale and started her on cyclodermC
(ciclopirox olamine and clobetasone butyrate.) The mother called me
back after finishing 12 days of treatment and said that it didn't help
and that she is still in pain. Her dermatologist said it must not be
thrush and left if at that.
I went back yesterday and saw:
Mothers nipples are fine, no cracks or sores but the nipples and areola
are a very strange purplish red color. Not normal looking at all.
There are tiny clusters of tiny bumps on the areola which don't look
like regular montgomery glands and look irratated. None of this hurts
except during feeding and then only where the baby's top lip touches.
Mom reported that Friday she tried pumping with an Avent hand pump,
which she normally pumps with well, and had tiny drops of blood on her
areola.
Baby's face is no longer crooked, tongue fills mouth when he cries,
labial frenulum seems thin and elastic but he does not gape. Mom brings
him nose to nipple, breast is dripping away, and he does fishy like
movements, open close, open close, and latches shallowly. He comes off
and goes back on frequently. Mom doesn't spray - just flows. He gulps
and gulps and gulps.
We tried many positions including mom on her back to slow down the flow
and keep baby on and even the Australian hold. Baby did do better with
the mother on her back but the mother felt no difference. With the baby
in the Australian hold we realized that the pain really was wherever the
baby's upper lip touched. We tried straddle hold, football, cross
cradle... No matter how the baby looked or how the mom's nipple looked
coming out of his mouth, the pain was the same - across from baby's
upper lip. No nipple pain. Doesn't hurt in between feeds.
Baby has a terrible rash of some sort on his bottom, which had been on
his face and torso as well. There were small red spots on his tush
where the skin was broken. The mother said that they had been pus
filled blisters and were almost healed. The mother was treating it with
bactroban, cycloderm c and a diaper rash cream according to the doctor's
instructions. The rash came about a week ago, two weeks after mom's
areola's turned colors and began to hurt. Could this be some kind of
staph infection?
There's so much going on here that I can't figure out what is causing
what but her pain symtoms are not typical of a bad latch.
Please help, I'm stumped.
Thanks so much in advance,
Chayn in Israel, IBCLC
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