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Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 10 Nov 1999 21:01:32 EST
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I have a client nursing her second baby now 2 1/2 months old.  She started
out hyperlactating with bilateral sore cracked nipples mostly due to baby
working his way to end of nipple trying to handle the forceful MER and
prolonged engorgement.  Baby was gaining about 2 oz per day, but mom was
suffering.  She had her first mastitis at 2 weeks in one breast, then two
weeks later in the opposite breast.  We are doing cabbage and cold
compresses.  She's drinking sage tea to help reduce supply.  The 2nd mastitis
was about two weeks later and improved about two days after starting of
antibiotics and then flared up so bad that she was hospitalized for two days
on IV antibiotics and continued on antibiotics after returning home for a
total of 10-days.  The OB did do an ultrasound at the time of hospitalizing
and found no abscess.

She decided to just pump as she can keep the breast empty best if she pumps.
She is still drinking sage tea and trying to reduce supply and supply has
lower though still higher than baby's daily intake.  Nipples healing is slow
even though she is using Dr. Jack's APNO four times per day.  After a couple
of weeks of just pumping, she decides to return the baby to breast and comes
into the office.  He nurses well despite all the bottles, has a good latch.
He has trouble staying on the R-side as the MER is very forceful and he gulps
and comes off.  But, he did well with the L-side.  I do notice that the
nipple on the L-side is still inflamed and bright pink.  I encourage mom to
continue to use APNO.  Within a week, she has a mastitis in the L-side again.
 Mom mentioned that she found what looked like pus on her nursing pads and
began to notice a grainy residue in the bottom of the bottle when she pumped.
 We talked about the possibility of an abscess at the nipple and I suggested
that she see a surgeon instead of the OB.  The surgeon said there is no way
to detect a nipple abscess and that the baby's mouth should be tested for
staph.  The ped said sure there could be staph in the baby's mouth, but if
baby isn't symptomatic why treat with antibiotics which mom agrees.  I have
never had a case like this one or a nipple that I could not get to heal.  The
lower portion of the L-nipple from  3:00 to 9:00 is bright pink inflamed and
extremely sore to the touch from tip to the base of nipple, upper half is
fine.  Mom feels like something is festering in this nipple.  Any suggestion
would be so welcomed.

Warm regards,
Pat Lindsey, IBCLC - Lactation Services
Pediatrics Plus Staff LC & Private Practice
Orlando, FL

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