Hi All,



I need some fast answers.  A client of mine has chronic sore nipples with a
crack around the base of both nipples.  Even with correct latch and
positioning, and baby having no physical issues that would cause a problem,
she is in pain.  We took baby off the breast for two days because the pain
was getting so bad (she acknowledged possible inadequate latch a few times
on her part and just suffering through but not at every feed) and the cracks
were not healing.  Started her on (otc) APNO and pumping with hospital grade
pump but pumping was hurting and there was no healing going on.  She got
larger flanges - didn't help.  She got comfort shields - did not help.  A
week later.(was only supposed to be 2 days.) I encouraged her to go to the
Dr and get a culture and rule out staph or some other bacterial or fungal
infection.  Here is where I am frustrated.



Dr refused to do a culture - said it would take too long to get results
back.  Instead he says she must have mastitis (with NO outward or other
physical symptoms of mastitis), states it is definitely not fungal, and puts
mom on oral amoxicillin at 1000mg 3 times per day and tells her to take baby
OFF breast - pump and dump as Amox not safe while breastfeeding.  Hale
states that 875 BID is fine - but I can't find any info stating that nearly
2 times that dose is fine.  I suspect it is.but I can't give her information
on a dosage I don't have.  Also - no topical antibiotic to assist with
healing.



Now I have a mom who is afraid to take the medication, afraid to nurse baby
or give him the milk if she does take the medication, and is tired of
hurting and just wants to nurse her little one without pain.



All input greatly appreciated and the sooner the better.  Mom is considering
taking the high dose of amox and putting baby on ABM - even tho we discussed
the risks of ABM, and the possibility of simply taking 500mg 3 times per day
(which would be a standard and safe dose) and keeping baby on the breast.
Quite frankly, I'd just like to know what is going on with her nipples.I
suspect bacterial or fungal issue.but no one will culture her!  Sigh.



Please e-mail privately at [log in to unmask]



Warmly

Jaye





Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net




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