Hi all,
Have a client that I would appreciate any input on due to confounding
variables.
G2P2, currently exclusively BF 8 wk old. 1st baby unsuccessful nursing
due to ? latch problems. I did not know her then.
Chief complaints - extremely sore rt nipple, very small (2 mm) cut or
crack on nipple at the 1 o'clock position that opens with each nursing
session. The cut has healed, gotten worse, on and off. Nipples pink but
no itching, burning, other pain, no breast pain, no vaginitis, no thrush
visible in baby's mouth, no recent abx.
History: mastitis resolved treated with abx full course, followed by
probable thrush, mom treated with nystatin cream x 10d and baby treated
with nystatin susp x 10 days starting May 30, while using other
anti-thrush measures. Symptoms resolved.
Other current complaint - baby is miserable; fussy during feeds at 2nd
breast, fussy, gassy, colicky after feeds. Burps poorly, passes lots of
gas. On Mylicon (simethicone) drops and Levsin (hyoscyamine) syrup per
pediatrician. Baby 10 lbs, 2 oz at birth, at 2 wks wt about 13 lbs, now
at 8 wks about 17 lbs. Has red, dry rash on face, neck, back and ears dry
and flaky, on special shampoo (? name) and cortisone cream per pedi.
Stools yellow, normal about every other day. No supplements ever, no
solids ever.
Pertinent facts: mom loves dairy, consumed tons during pregnancy, and
loves milk, yogurt, cheese, ice cream. Tried no dairy x 6 days with no
improvement, but did not read labels, etc. Maternal aunt with milk
allergy.
Mom stops baby after 15 min on 1st breast and about 20 min on second.
I can't remember everything as I don't have chart here at home. My
differential diagnoses are:
1. milk allergy -- recommended dairy free x 21 days and gave lots of info
on this
2. oversupply/overactive letdown -- didn't really fit the picture of
maternal symptoms (no leaking alot, no spraying, only 1 prev. mastitis)
and no green, explosive stools, etc; however does have great wt gain, and
is maybe clamping down on rt nipple. Mom feels rt side is fuller but does
not notice any forceful letdowns, etc. I did recommend finish 1st breast
1st. Nipples misshapen after feeds with diagonal stripe (uses cradle
hold). Deep latch, no tongue tie, somewhat "chewing" motion with digital
exam.
3. persistant thrush
4. combination of any and all above.
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, USA
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