Colleagues,
Can anyone offer me some assistance?  I am dealing with a client who, in the past 6 weeks has had a plugged duct every 2 days in the same breast and same location.  She  states this breast does not empty as well as the other one.  She also has a little red dot on the nipple that is incredibly painful and keeps recurring.  Her 7 month old baby feeds exactly the same on both breasts.  She finds it gets worse if she is really full.  She had been giving the baby a supplement of expressed breast milk or formula at the last feed at night.  The baby feeds 3 - 4 times during the day and twice at night.  The longest the baby goes between feeds is from 10 PM to 3AM, otherwise the baby usually feeds on demand.  Baby has been on solids for past 2 months.  She has a familial tendency towards developing anemia.  She describes herself as having "weak shoulders and a tense upper back". Her bra is loose and comfortable.  Putting a warm cloth on the breast prior to feeds helps.  She uses breast compression with feeds with good effect and has managed, so far, to keep the plugged duct from developing into a mastitis.  

I suggested she see her physician to determine if she has anemia or some other breast condition that is restricting the drainage of that breast.  I also suggested she limit her saturated fat intake and take lecithin daily (as per Ruth Lawrence).  Because she waits until she develops a plugged duct to massage breasts and use breast compression with all feeds, to ensure adequate breast drainage.  She states the baby will not take the breast while being held in any position than the cradle hold. 

Does anyone have any other suggestions or any ideas what the "red dot" is??

TIA!!

Jeanne Hagreen, RN, BSN,. IBCLC
Prince George, BC, CANADA
"One LC in the wilderness"

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