Saw mom on Friday who had a VERY sore left nipple - she only nurses on one side due to history of multiple breast surgeries and problems beginning in adolescence on the other breast. I found a small traumatized area - an open wound on the underside of the nipple. Mom had not been able to see this until now due to its location. No history of trauma to the area - no bite (baby is 8 months) or anything else. Baby had been pulling back from the breast and seeming more frustrated when feeding since the pain began. I surmised that this was probably due to inhibited letdown due to mom's pain. Baby had had a yeasty diaper rash a week or so earlier which had cleared up. No other history of yeast in either mom or baby. No oozing, no bleeding from the area. I had mom start RX APNO after every feeding, do salt water soaks, take ibuprofen, and pump when she needed to.

She calls today and says sore is much bigger and more painful. The APNO - which she has used for 3 plus days now - has not helped at all. She feels there has been no relief at all. I advised her to see her doctor to make sure we're not dealing with an infection that might require oral abx. She had no other symptoms so I'm really at a loss. My thoughts were to use a stronger topical antibiotic but still felt safer having her see her doc. She will call me back after she sees him. Any thoughts?

Thanks,

Becky Flora, IBCLC


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