(Photo: Hugh Laurie as Dr. House, the maniac-genius doctor specialized in diagnostic medicine in the TV series with the same name)
To diagnose is being a detective. It’s a search for evidence, means and possibilities. As a true Sherlock the diagnostician (is that even an English word?) has to combine and deduce in order to find answers. Lactation Consultants get their share, too. Some lactational diagnoses are easily made, other are more tricky. It can make a lactation consultant feel like being Dr. House in the art of shoving, puzzling and combining all important, lesser, coinciding, forgotten and later added factors and symptoms. Take, for example, the mother reporting painful feeding, a white nipple and pain after feeding as well. The combining an deducing lactation consultant will want to know what pain, where, exactly when, how long? And white: what kind of white, where: in or on, always or receding or changing? Often ‘’pain and white nipple’’ is promptly diagnosed as thrush; followed by a fungus-treatment, which often gives no to little result. The next diagnosis often is not ‘’probably it wasn’t thrush at all’’, but ‘’we probably didn’t get the treatment well’’ and a new treatment is started or the current one intensified and prolonged. But it might as well not have been thrush in the first place, but Raynaud’s phenomenon. That, too, is extremely painful during and for some time after feeding. The nipple turns white as well, but this is not a plague, but a discoloration, due to interruption in the blood flow. Still, it is not that strange that thrush is more thought of than Raynaud’s. After all, Candida Albicans is found in the oral cavity of one third of all breastfed babies (and in two thirds of all formula fed babies!) and on the nipple and areolae of one third of all lactating and a bit over one sixth of all non-lactating mothers (Zolner 2003). despite the common occurrence of thrush in the nursing couple little recent literature is to be found on its treatment. Many physicians ridicule thrush in mothers and children: ‘’it’s not serious and will get by on itself, anyway’’. BY doing so they totally ignore the pain it can cause both mother and child and the increased risk of premature weaning as a result. Hanna and Cruz (2011) strongly advice HCPs to be more alert on thrush symptoms and to treat adequately, however difficult this may prove to be. Raynaud’s is well-known as phenomenon in hand and feet, lesser so in the breasts of nursing mothers. Treatment is complicated, probably because the causes are relatively unknown, but probably divers (Anderson et al, 2004). Sometimes antihypertensives are used, with very little effect. Other options used are nutritional supplements of vitamin B6, magnesium and calcium, and, recently heard, omega 3 and 6. Pinching of the nipples (by bad sucking habits or anomalies in the mouth), temperature changes and cold are some of the triggers for Raynaud’s and should therefore be prohibited. It is an ongoing trial and error mission, so: lactation consultants try and be a Sherlock Holmes meets Dr. House.
Zöllner MS, Jorge AO. Candida spp occurrence in oral cavities of breast-feeding infants and in their mothers' mouths and breasts. Pesqui Odontol Bras. 2003 Apr–Jun;17(2):151–5.
Louisa Hanna, MD and Stacie A Cruz, MD: Candida Mastitis: A Case Report. Perm J. 2011; 15(1):62–64.
Anderson JE, Held N, Wright K.: Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360-4.
To diagnose is being a detective. It’s a search for evidence, means and possibilities. As a true Sherlock the diagnostician (is that even an English word?) has to combine and deduce in order to find answers. Lactation Consultants get their share, too. Some lactational diagnoses are easily made, other are more tricky. It can make a lactation consultant feel like being Dr. House in the art of shoving, puzzling and combining all important, lesser, coinciding, forgotten and later added factors and symptoms. Take, for example, the mother reporting painful feeding, a white nipple and pain after feeding as well. The combining an deducing lactation consultant will want to know what pain, where, exactly when, how long? And white: what kind of white, where: in or on, always or receding or changing? Often ‘’pain and white nipple’’ is promptly diagnosed as thrush; followed by a fungus-treatment, which often gives no to little result. The next diagnosis often is not ‘’probably it wasn’t thrush at all’’, but ‘’we probably didn’t get the treatment well’’ and a new treatment is started or the current one intensified and prolonged. But it might as well not have been thrush in the first place, but Raynaud’s phenomenon. That, too, is extremely painful during and for some time after feeding. The nipple turns white as well, but this is not a plague, but a discoloration, due to interruption in the blood flow. Still, it is not that strange that thrush is more thought of than Raynaud’s. After all, Candida Albicans is found in the oral cavity of one third of all breastfed babies (and in two thirds of all formula fed babies!) and on the nipple and areolae of one third of all lactating and a bit over one sixth of all non-lactating mothers (Zolner 2003). despite the common occurrence of thrush in the nursing couple little recent literature is to be found on its treatment. Many physicians ridicule thrush in mothers and children: ‘’it’s not serious and will get by on itself, anyway’’. BY doing so they totally ignore the pain it can cause both mother and child and the increased risk of premature weaning as a result. Hanna and Cruz (2011) strongly advice HCPs to be more alert on thrush symptoms and to treat adequately, however difficult this may prove to be. Raynaud’s is well-known as phenomenon in hand and feet, lesser so in the breasts of nursing mothers. Treatment is complicated, probably because the causes are relatively unknown, but probably divers (Anderson et al, 2004). Sometimes antihypertensives are used, with very little effect. Other options used are nutritional supplements of vitamin B6, magnesium and calcium, and, recently heard, omega 3 and 6. Pinching of the nipples (by bad sucking habits or anomalies in the mouth), temperature changes and cold are some of the triggers for Raynaud’s and should therefore be prohibited. It is an ongoing trial and error mission, so: lactation consultants try and be a Sherlock Holmes meets Dr. House.
Zöllner MS, Jorge AO. Candida spp occurrence in oral cavities of breast-feeding infants and in their mothers' mouths and breasts. Pesqui Odontol Bras. 2003 Apr–Jun;17(2):151–5.
Louisa Hanna, MD and Stacie A Cruz, MD: Candida Mastitis: A Case Report. Perm J. 2011; 15(1):62–64.
Anderson JE, Held N, Wright K.: Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360-4.
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