Hello, I have permission from mom to post, and I would really like your input on this one, because I am stumped. Thinking maybe I should see mom and baby again, maybe I missed something the first time.
Mom is a G4 P4, her baby is 4 weeks old. She is having burning pain in her breast on one side, mostly after feeds. She says this has been going on since baby was 1.5 wks. I looked at baby's mouth, no visible restrictions noted in tongue or lip, although I am not an expert with TT, LP, but I have seen my share. Baby did have a little milk on the back of tongue, that seemed to wipe off easily. I know this can be a sign of post. TT. No visible signs of yeast in mouth.
Mom has a history of oversupply with each child, but feels it is under control with this child at this time. Observed baby feeding, had mom do a laid back position, thinking it would help with deeper latch and milk flow if fast. Mom latched baby well, tips given on getting a deep latch, mom verbalized a comfortable latch. Baby did cough/choke once during feeding, maybe still a little oversupply, or tongue issues? No nipple creasing noted after baby came off of breast. No redness, skin irritation, or white noted on nipple.
Mom latched baby on other side, after done with first side, and said, it is always perfectly comfortable, and she never has any pain during or after feeding on this side.
Mom complained 3-4 times of burning pain on the side baby had just finished nursing on, while nursing on the non-painful side, and after baby was completely done. We looked quickly at that side (nipple) to see if white/discolored, but it was not. I showed mom how to compress at the base of nipple to encourage blood flow to nipple, it did get a darker color of pink. The burning goes away, but comes back again and again. Mom describes as a burning shooting pain, in nipple and radiating throughout breast.
Baby did spit up after feeding. Mom says baby is a happy spitter, but has discussed a script for zantac with baby's pedi, in case baby starts to show signs of pain with the reflux. Wondering if baby is backing off of the nipple a little d/t reflux, causing some compression?
We discussed continuing to practice a deep latch in a laid back position, using cloth breast pads, as they may be warmer than disposable. I mentioned chiropractor care for both mom and baby, not sure if she is open to this. She denies any neck of back problems. I encouraged her to watch for signs of yeast in baby's mouth, and any signs on her breast. We discussed maybe treating for yeast even though not sure if this, with so few symptoms in mom/baby.
Mom called me a couple of days after I saw them and said the burning pain was worse, especially at night and she had gotten a script from her OB to start diflucan. She asked her pedi to treat baby too, but he said he would not, since baby had no symptoms. Mom also got a script for APNO.
I really want to help this mom, but I am puzzled by what is going on. Your thoughts/suggestions on this one would be appreciated. Thanks in advance!
Karen
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