Re: frequent blebs and engorgments

[Guest guest]

a, it would be wonderful if you could share the pictures. Thank you so much for offering.

Maybe if we collectively look at them we can collectively come up with some good suggestions.

Jan Barger

Hi all!

I’m a PP-IBCLC in Rome (Italy).

Here I am to ask your help for a client of mine.

She has an almost 6 mos. baby girl . in the last 6 weeks (about.. unfortunately I forgot her sheet at office and can check for details just tomorrow) she started to have a bleb on a nipple together with engorgements. In a first moment, the problem was about each 10 days, and she went to the hospital where they punched/holed (sorry for my poor English) it. In a second moment, the bleb came back and came and came more often, sometimes in only a couple of days.

Latching became even more painful and the mom is really upset and overwhelmed.

I saw her 3 days ago. I noted that the latch wasn’t so wide , that is not a problem in a 5 ½ mo.s baby, but as the mom has so much pain, I suggested to try to make her open the mouth wider. I gave her all the suggestions for blebs, but it seems nothing works. I saw some bleaching after feeding too.

I am so sorry for her because she is really a very motivated mother but is really very painful

She sent me a complete “photo history†of these blebs. Can I share with you? Even in PDF it is heavy (10 Mb) so I could put it into the list’s Files folder .

Let me know if it’s useful.

She gave me her permission to share pictures and use for classes and teaching too J

I thank you very very much in advance for your suggestions and ideas!!

Hugs

a Carabetta, PP- IBCLC

www.latteecoccole.it

[Guest guest]

Hello, a.

It would be interesting to see the photos, if you can figure out how to upload them to our Files section. But I also wonder about baby at breast. Do you happen to notice if the baby's cheeks flatten or dimple in when the jaw is dropped during a suck? If they flatten or dimple, that means the baby is moving his tongue incorrectly. Of course you would still need to try to figure out *why* he is moving the tongue incorrectly if he had previously been doing fine. But he is 6 months old. I am wondering if perhaps as he was learning to sit up, he fell over and banged his jaw. Do you have anyone in your country who does craniosacral therapy or pediatric chiropractic? You can check for a local craniosacral therapy practitioner at http://www.upledger.com/findapractitioner.asp. If baby is sucking incorrectly, the pressure of that might account for trauma that causes blebs.

Or could the baby perhaps have an ear infection? Fluid in the ear can cause pain when baby tries to move his jaw, so sometimes they stop opening wide during ear infections.

Do you have lecithin available in your country? Taking 1200mg to 3600mg lecithin (by capsules) each day can help to lessen the recurrence of plugged ducts and nipple blebs.

Here's what I suggest for a "recurring" nipple bleb. Personally, I think that it often really isn't "recurring", but more likely "never quite cleared up in the first place." I think that when that milk sits at the front of the nipple pore, thickened, so it can't get out, then the milk behind it in that particular duct also thickens as it sits there unable to move

out. Then, eventually, the mother finds a way to get the white spot at the nipple pore to go away, and she temporarily feels better. I think she took the pressure off the tissue at the nipple pore. But that other milk that thickened as it couldn't get out, is still there, just back farther in the breast where it can't be seen. Then as baby nurses a few more times, or another day or two, he gradually pulls that toothpaste-thick milk down to the front of the duct, and that thick milk puts pressure on the tissue around the nipple pore again, and mom is in pain again. But it's not a "new" bleb (at least, this is my conjecture), but just more stuck milk finally making its way down the duct.

So I suggest that moms take a pain reliever (like acetominphen or ibuprofen) right before they nurse the baby, preferably when there is another adult in the house to take care of the baby after they've finished nursing. Otherwise, if she is alone, she can try to do this when she expects baby to take a long nap after nursing. She takes the pain reliever, so that it has time to get into her system, and I warn her that what I'm suggesting will not feel good. (So she isn't thinking harshly of me while she's in the tub, thinking I'm a complete idiot.) She breastfeeds,

so there's the least amount of milk/pressure in the breast as possible. Then she gets in the tub, with the water high enough that she can comfortably lean over and submerge her breasts. She soaks them for 3-4 minutes, to let the heat help to widen the ductwork. Then she starts at the nipple and massages and expresses the nipple to move out any

thickened milk she can. Then she moves back to the areola and massages and expresses a strip about an inch wide, all the way around the breast. Then she moves back about an inch toward the chest wall, and again massages and expresses any milk she can out the front of the breast. She continues to move back on the breast, inch by inch, constantly moving the milk towards the nipple. (If she starts back at the chest wall, she's just running milk into the blockage and increasing the pressure.) I warn her that if she manages to express any thickened milk, it is likely to feel unpleasant or even painful, but that if she manages to get it out, she will feel much better afterwards. I also warn her of two more things: 1. If she gets out a plug of thickened milk, it is likely to look kind of stringy and clumpy and cottage-cheesy in the water. If you don't warn her and she sees this, she will absolutely freak out. 2.

Then you must immediately reassure her that if she doesn't see this in the water, but the pain/plug/bleb goes away/does not return, then it won't hurt her baby to have swallowed it down. It's just breastmilk that lost some of its water and got thick, but it still has all the antibodies and nutrients it ever had. Otherwise, the mother's mind immediately goes from "don't worry if you see this in the water" to "what if the baby swallows that awful-looking stuff?". I suggest that they do this three nights in a row. It very frequently solves the problem.

Good luck with this complicated case!

Dee Kassing

Subject: frequent blebs and engorgmentsTo: Date: Friday, December 16, 2011, 12:42 PM

Hi all!

I’m a PP-IBCLC in Rome (Italy).

Here I am to ask your help for a client of mine.

She has an almost 6 mos. baby girl . in the last 6 weeks (about.. unfortunately I forgot her sheet at office and can check for details just tomorrow) she started to have a bleb on a nipple together with engorgements. In a first moment, the problem was about each 10 days, and she went to the hospital where they punched/holed (sorry for my poor English) it. In a second moment, the bleb came back and came and came more often, sometimes in only a couple of days.

Latching became even more painful and the mom is really upset and overwhelmed.

I saw her 3 days ago. I noted that the latch wasn’t so wide , that is not a problem in a 5 ½ mo.s baby, but as the mom has so much pain, I suggested to try to make her open the mouth wider. I gave her all the suggestions for blebs, but it seems nothing works. I saw some bleaching after feeding too.

I am so sorry for her because she is really a very motivated mother but is really very painful

She sent me a complete “photo history†of these blebs. Can I share with you? Even in PDF it is heavy (10 Mb) so I could put it into the list’s Files folder . Let me know if it’s useful. She gave me her permission to share pictures and use for classes and teaching too J I thank you very very much in advance for your suggestions and ideas!! Hugs a Carabetta, PP- IBCLC www.latteecoccole.it

[Guest guest]

Dee,Thank you for sharing such great info! Walters, IBCLCIn Home Lactation Specialists

 

Hello, a.

    It would be interesting to see the photos, if you can figure out how to upload them to our Files section.  But I also wonder about baby at breast.  Do you happen to notice if the baby's cheeks flatten or dimple in when the jaw is dropped during a suck?  If they flatten or dimple, that means the baby is moving his tongue incorrectly.  Of course you would still need to try to figure out *why* he is moving the tongue incorrectly if he had previously been doing fine.  But he is 6 months old.  I am wondering if perhaps as he was learning to sit up, he fell over and banged his jaw.  Do you have anyone in your country who does craniosacral therapy or pediatric chiropractic?  You can check for a local craniosacral therapy practitioner at http://www.upledger.com/findapractitioner.asp.  If baby is sucking incorrectly, the pressure of that might account for trauma that causes blebs.

 

Or could the baby perhaps have an ear infection?  Fluid in the ear can cause pain when baby tries to move his jaw, so sometimes they stop opening wide during ear infections.

 

Do you have lecithin available in your country?  Taking 1200mg to 3600mg lecithin (by capsules) each day can help to lessen the recurrence of plugged ducts and nipple blebs.

 

   Here's what I suggest for a " recurring " nipple bleb.  Personally, I think that it often really isn't " recurring " , but more likely " never quite cleared up in the first place. "   I think that when that milk sits at the front of the nipple pore, thickened, so it can't get out, then the milk behind it in that particular duct also thickens as it sits there unable to move

out.  Then, eventually, the mother finds a way to get the white spot at the nipple pore to go away, and she temporarily feels better.  I think she took the pressure off the tissue at the nipple pore.  But that other milk that thickened as it couldn't get out, is still there, just back farther in the breast where it can't be seen.  Then as baby nurses a few more times, or another day or two, he gradually pulls that toothpaste-thick milk down to the front of the duct, and that thick milk puts pressure on the tissue around the nipple pore again, and mom is in pain again.  But it's not a " new " bleb (at least, this is my conjecture), but just more stuck milk finally making its way down the duct.

  So I suggest that moms take a pain reliever (like acetominphen or ibuprofen) right before they nurse the baby, preferably when there is another adult in the house to take care of the baby after they've finished nursing.  Otherwise, if she is alone, she can try to do this when she expects baby to take a long nap after nursing.  She takes the pain reliever, so that it has time to get into her system, and I warn her that what I'm suggesting will not feel good.  (So she isn't thinking harshly of me while she's in the tub, thinking I'm a complete idiot.) She breastfeeds,

so there's the least amount of milk/pressure in the breast as possible.  Then she gets in the tub, with the water high enough that she can comfortably lean over and submerge her breasts.  She soaks them for 3-4 minutes, to let the heat help to widen the ductwork.  Then she starts at the nipple and massages and expresses the nipple to move out any

thickened milk she can.  Then she moves back to the areola and massages and expresses a strip about an inch wide, all the way around the breast.  Then she moves back about an inch toward the chest wall, and again massages and expresses any milk she can out the front of the breast.  She continues to move back on the breast, inch by inch, constantly moving the milk towards the nipple. (If she starts back at the chest wall, she's just running milk into the blockage and increasing the pressure.)  I warn her that if she manages to express any thickened milk, it is likely to feel unpleasant or even painful, but that if she manages to get it out, she will feel much better afterwards.   I also warn her of two more things:  1.  If she gets out a plug of thickened milk, it is likely to look kind of stringy and clumpy and cottage-cheesy in the water.  If you don't warn her and she sees this, she will absolutely freak out.   2. 

Then you must immediately reassure her that if she doesn't see this in the water, but the pain/plug/bleb goes away/does not return, then it won't hurt her baby to have swallowed it down.  It's just breastmilk that lost some of its water and got thick, but it still has all the antibodies and nutrients it ever had.  Otherwise, the mother's mind immediately goes from " don't worry if you see this in the water " to " what if the baby swallows that awful-looking stuff? " .   I suggest that they do this three nights in a row.  It very frequently solves the problem.

 

Good luck with this complicated case!

     Dee Kassing

Subject: frequent blebs and engorgments

To: Date: Friday, December 16, 2011, 12:42 PM

 

Hi all!

I’m a PP-IBCLC in Rome (Italy).

Here I am to ask your help for a client of mine.

She has an almost 6 mos. baby girl . in the last 6 weeks (about.. unfortunately I forgot her sheet at office and can check for details just tomorrow) she started to have a bleb on a nipple together with engorgements. In a first moment, the problem was about each 10 days, and she went to the hospital where they punched/holed (sorry for my poor English) it. In a second moment, the bleb came back and came and came more often, sometimes in only a couple of days.

Latching became even more painful and the mom is really upset and overwhelmed.

I saw her 3 days ago. I noted that the latch wasn’t so wide , that is not a problem in a 5 ½ mo.s baby, but as the mom has so much pain, I suggested to try to make her open the mouth wider. I gave her all the suggestions for blebs, but it seems nothing works. I saw some bleaching after feeding too.

I am so sorry for her because she is really a very motivated mother but is really very painful

She sent me a complete “photo history” of these blebs. Can I share with you? Even in PDF it is heavy (10 Mb) so I could put it into the list’s Files folder . Let me know if it’s useful. She gave me her permission to share pictures and use for classes and teaching too J I thank you very very much  in advance for your suggestions and ideas!! Hugs a Carabetta, PP- IBCLC www.latteecoccole.it  

[Guest guest]

Hi a,

The doctor I work for had bleb tissue analyzed by a lab and it was discovered that a bleb is inflammatory cells. 

She prescribes a steroid ointment to calm down the inflammation.  Of course it's also important to determine why the baby is causing damage in the first place. 

Healy

Seattle, WA

 

Hi all!I’m a PP-IBCLC in Rome (Italy).

Here I am to ask your help for a client of mine.She has an almost 6 mos. baby girl . in the last 6 weeks (about.. unfortunately I forgot her sheet at office and can check for details just tomorrow) she started to have a bleb on a nipple together with engorgements. In a first moment, the problem was about each 10 days, and she went to the hospital where they punched/holed (sorry for my poor English) it. In a second moment, the bleb came back and came and came more often, sometimes in only a couple of days.

Latching became even more painful and the mom is really upset and overwhelmed.I saw her 3 days ago. I noted that the latch wasn’t so wide , that is not a problem in a 5 ½ mo.s baby, but as the mom has so much pain, I suggested to try to make her open the mouth wider. I gave her all the suggestions for blebs, but it seems nothing works. I saw some bleaching after feeding too.

I am so sorry for her because she is really a very motivated mother but is really very painfulShe sent me a complete “photo history” of these blebs. Can I share with you? Even in PDF it is heavy (10 Mb) so I could put it into the list’s Files folder .

Let me know if it’s useful.She gave me her permission to share pictures and use for classes and teaching too J

I thank you very very much  in advance for your suggestions and ideas!!Hugs

a Carabetta, PP- IBCLCwww.latteecoccole.it

 

[Guest guest]

That's interesting, though I wonder if the bleb IS inflammatory cells, or if the bleb CAUSES inflammation. And what kind of skin is over the bleb that it is so darn hard to break to get the milk out???

Jan

The doctor I work for had bleb tissue analyzed by a lab and it was discovered that a bleb is inflammatory cells. She prescribes a steroid ointment to calm down the inflammation. Of course it's also important to determine why the baby is causing damage in the first place.

[Guest guest]

yes, hard to say which comes first. Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- Subject: Re: frequent blebs and engorgmentsTo: Date: Saturday, December 17, 2011,

10:59 AM

That's interesting, though I wonder if the bleb IS inflammatory cells, or if the bleb CAUSES inflammation. And what kind of skin is over the bleb that it is so darn hard to break to get the milk out???

Jan

The doctor I work for had bleb tissue analyzed by a lab and it was discovered that a bleb is inflammatory cells. She prescribes a steroid ointment to calm down the inflammation. Of course it's also important to determine why the baby is causing damage in the first place.

[Guest guest]

Has she tried wearing a cotton ball soaked in olive oil between feedings? That's worked for a couple of moms I've worked with. Heinz, BA IBCLCBeach Babies Lactation Support, LLC From: ibclc@...Sender: Date: Sat, 17 Dec 2011 13:59:19 -0500 (EST)To: < >ReplyTo: Subject: Re: frequent blebs and engorgments That's interesting, though I wonder if the bleb IS inflammatory cells, or if the bleb CAUSES inflammation. And what kind of skin is over the bleb that it is so darn hard to break to get the milk out??? Jan The doctor I work for had bleb tissue analyzed by a lab and it was discovered that a bleb is inflammatory cells. She prescribes a steroid ointment to calm down the inflammation. Of course it's also important to determine why the baby is causing damage in the first place.

[Guest guest]

Sorry it has taken so long to reply – agree with all Dee has had to offer.  For moms with this issue, I also ask about the amount of dairy fat in their diet.  Here in the US, I have found some moms eating the high fat ice cream, lots of cheddar cheese, etc.  need to cut down on this and supplement with lecithin. From: [mailto: ] On Behalf Of aSent: Friday, December 16, 2011 1:43 PMTo: Subject: frequent blebs and engorgments Hi all!I’m a PP-IBCLC in Rome (Italy).Here I am to ask your help for a client of mine.She has an almost 6 mos. baby girl . in the last 6 weeks (about.. unfortunately I forgot her sheet at office and can check for details just tomorrow) she started to have a bleb on a nipple together with engorgements. In a first moment, the problem was about each 10 days, and she went to the hospital where they punched/holed (sorry for my poor English) it. In a second moment, the bleb came back and came and came more often, sometimes in only a couple of days.Latching became even more painful and the mom is really upset and overwhelmed.I saw her 3 days ago. I noted that the latch wasn’t so wide , that is not a problem in a 5 ½ mo.s baby, but as the mom has so much pain, I suggested to try to make her open the mouth wider. I gave her all the suggestions for blebs, but it seems nothing works. I saw some bleaching after feeding too.I am so sorry for her because she is really a very motivated mother but is really very painfulShe sent me a complete “photo history” of these blebs. Can I share with you? Even in PDF it is heavy (10 Mb) so I could put it into the list’s Files folder .Let me know if it’s useful.She gave me her permission to share pictures and use for classes and teaching too JI thank you very very much in advance for your suggestions and ideas!!Hugsa Carabetta, PP- IBCLCwww.latteecoccole.it

[Guest guest]

I'm sure there are different ways a bleb can start; repeated trauma at the nipple, plugs/damage in the duct... 

The white spot is inflammatory tissue though, not milk.  It's not always blocking milk from coming out.

These pictures look more suspicious for infection to me though.

Healy

Seattle, WA

 

That's interesting, though I wonder if the bleb IS inflammatory cells, or if the bleb CAUSES inflammation.  And what kind of skin is over the bleb that it is so darn hard to break to get the milk out???

 

Jan  

The doctor I work for had bleb tissue analyzed by a lab and it was discovered that a bleb is inflammatory cells.  She prescribes a steroid ointment to calm down the inflammation.  Of course it's also important to determine why the baby is causing damage in the first place.