Hello, Ann.
       I have heard the word "lactoma" before, though I can't find it in my
medical dictionary or any of my breastfeeding texts.  I think they are using it
as another name for galactocele.
       More concerning for me is your description of this baby--somewhat
listless and in the 10th percentile for weight.  You also state that he nurses for
"at least 45 minutes" each time he breastfeeds.  In my experience, this is
indicative of a feeding problem.  Although a baby may take a longer feeding
occasionally during the day, such as when he's getting ready for a long sleep at
night, when it takes this long *at every feeding*, and we combine that with
listlessness and slow weight gain, these clues usually point to some problem with
feeding.  I find that when babies are nursing well, they are usually done in
20-30 minutes, with sometimes some extra minutes for falling asleep.  This
baby falls asleep frequently.  That can actually be withdrawal, rather than true
sleep.  Ask the mother this:  "If you take him away from the breast when he
falls asleep, does he immediately wake up and display hunger cues?  Then you put
him back to breast and he's asleep in two minutes.  Take him away and he
wakes up again?"  If she says yes, then this baby is withdrawing from the breast
in the only way he can.  He can't tell her what the problem is, and he can't
walk away, so he goes "to sleep", although it's not a true sleep as evidenced by
how alert he becomes as soon as he's taken away from the breast.
       Although plugged ducts can happen for a variety of reasons, poor
feeding can definitely lead to frequent plugs.  Someone with experience in sucking
problems needs to observe this mother-baby pair during a breastfeeding.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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