I would appreciate any thoughts on helping this Mom. Baby is 2 months old and since about day three Mom has been so sore and red she quit BF and started pumping. She can’t remember having scabs or bleeding. She is still sore when she pumps but not as bad.  She is using 27mm shields and occasionally 30 mm shields. She wears shells to keep the bra off her nipples but hurts when anything touches her, even shower water. She latches baby every couple of days and the baby nurses well, but is so sore after about 10 minutes she has to take her off.  Baby still goes to the breast readily but is getting a little lazy at eating.  



Observation: Red irritated nipples and small area of areola, about the size of the breast shield. Tip of the nipple is dark red, almost purple. When she came for an OP evaluation it stayed purple almost the whole time in my office, an hour +. Has a small cleft in both nipples but not appear any more irritated than the skin around it. Nipple turns dark red and gets much larger when pumping. Examined the baby’s mouth and tongue- no issues. Observed baby latch and she did well, nothing that should give Mom this degree of pain and redness. No nipple creasing when the baby came off.  She still has the same amount of soreness even when she does not latch the baby and pumps for several days. Mom states she usually does not have sensitive, skin or nipples.  She has no medical history and no allergies.  She pumps about 6 ounces at a sitting. 



Does not look or act like yeast. No other s/s in Mom or baby. Has none of the typical symptoms of vasospasm. No increased pain on temperature changes, no whiteness on the nipple or color changes. Has used APNO for a week or more and no changes. Uses heat before nursing or pumping, is still sore and red. I encouraged to have to look at anything environmental (pads, bra pads, soap, etc.) She has been trying to work on this for 2 months and tried many things. Anything we are missing?



Dianne 





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