Dear Friends,
Please help. Mom gave me permission to post.
I first saw mom and baby when the baby was 6 days old. The mother was complaining about pain during breastfeeding, particulary on one breast.
Pregnancy and labor were uneventful and without pain medications. Baby roomed in in the hospital and baby only breastfed. We worked on positioning, baby latched deeply and then would back off and on to the nipple. I noticed that the baby's face was assymetrical. The doctors had told the parents that it would straighten out with time but I thought it was affecting the breastfeeding and suggested CST. Moms milk dripped all the time. Baby gained 380 grams that week.
Mom went to 3 sessions of CST with a practitioner that I refer to often. After the third time the practitioner said that the baby was fine and there was no reason to continue. Mom said that she felt that the baby was latching better.
At 3 weeks old mom called reporting thrush like symtoms. She went to her obgyn who diagnossed thrush and started her on fluconazale (diflucan) but at a very low dose. The mom then went to a dermatologist who upped her dosage of fluconazale and started her on cyclodermC (ciclopirox olamine and clobetasone butyrate.) The mother called me back after finishing 12 days of treatment and said that it didn't help and that she is still in pain. Her dermatologist said it must not be thrush and left if at that.
I went back yesterday and saw:
Mothers nipples are fine, no cracks or sores but the nipples and areola are a very strange purplish red color. Not normal looking at all. There are tiny clusters of tiny bumps on the areola which don't look like regular montgomery glands and look irratated. None of this hurts except during feeding and then only where the baby's top lip touches. Mom reported that Friday she tried pumping with an Avent hand pump, which she normally pumps with well, and had tiny drops of blood on her areola.
Baby's face is no longer crooked, tongue fills mouth when he cries, labial frenulum seems thin and elastic but he does not gape. Mom brings him nose to nipple, breast is dripping away, and he does fishy like movements, open close, open close, and latches shallowly. He comes off and goes back on frequently. Mom doesn't spray - just flows. He gulps and gulps and gulps.
We tried many positions including mom on her back to slow down the flow and keep baby on and even the Australian hold. Baby did do better with the mother on her back but the mother felt no difference. With the baby in the Australian hold we realized that the pain really was wherever the baby's upper lip touched. We tried straddle hold, football, cross cradle... No matter how the baby looked or how the mom's nipple looked coming out of his mouth, the pain was the same - across from baby's upper lip. No nipple pain. Doesn't hurt in between feeds.
Baby has a terrible rash of some sort on his bottom, which had been on his face and torso as well. There were small red spots on his tush where the skin was broken. The mother said that they had been pus filled blisters and were almost healed. The mother was treating it with bactroban, cycloderm c and a diaper rash cream according to the doctor's instructions. The rash came about a week ago, two weeks after mom's areola's turned colors and began to hurt. Could this be some kind of staph infection?
There's so much going on here that I can't figure out what is causing what but her pain symtoms are not typical of a bad latch.
Please help, I'm stumped.
Thanks so much in advance,
Chayn in Israel, IBCLC
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