Received a call from an emergency room physician regarding
the mother of a 7-month old.  Talked to both the physician
and to the mother.  I would like feedback ASAP as I plan to
see the mom tomorrow morning.

History as I understand it.  Mom nursed first child, now age
4, for a year without problems.  With this child she has had
4 bouts of mastitis, the last 3 weeks ago.  She didn't feel
the last episode was completely resolved.  She did see a
lactation consultant during the last bout of mastitis.  She
says her breast is rock hard--upper outer aspect.  The
doctor said the ultrasound today showed only [greater
desity--I think.]  Anyway, he seemed to indicate it did not
indicate a mass.   The mother said the doctor gave her a
shot of something, but no presription.  I asked her to be
sure to find out what it was before she left.  When I
suggested Rocephin, she thought that might have been it.
When I asked about fatigue in the last month, she agreed
that could be a factor.

Mother is nursing on the affected side in the cradle hold at
every feeding and at least every other feeding on the
unaffected side.  She is also using a Pump-In-Style to help
keep her milk flowing.  She said the doctor said to use heat
every 3 hours.  I told her to use it no more than 5 minutes
just before the feeding.  I explained to her that rest was
imperative.

I explained to her different was of nursing the baby "upside
down," either on all fours over baby with baby's feet below
her shoulder or on her side with baby's feet above her
head.  She said for his lower jaw to be in line with the
hard spot, he would have to be upside down.

My questions are, would cold packs be appropriate?  What is
the best way to keep milk flowing without causing or
increasing oversupply which would lead to plugged ducts and
repeated infections?  Neither the doctor nor mother
mentioned fever or flu symptoms.  I'm questioning whether or
not she needs antibiotics.  I will plan to contact her
obstetrician, but would like to make appropriate
suggestions/recommendations.  She wants a referral to a
breast surgeon, and I have sent message to local LCs for
suggestions of one who is familiar with lactating breasts.

Please respond privately as well as to the list as I am
NOMAIL.  Please indicate in your response if I may pass on
the response to the mother and whether or not I have
permission to use your name and credentials when doing so.

TIA.
--
Bonnie Jones, RN, ICCE, IBCLC from the sunny S.W. USA
mailto:[log in to unmask]

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