ask a gooroo
November 15, 2007 by Amy Spangler | 3 questions or comments
If I had a small measure of technology skill, there would be a feature on baby gooroo® called—ask a gooroo. Let it suffice to say—it’s coming, it’s coming.
Until then, I have decided to select a couple of questions each month from among the many questions submitted by individuals, and invite members of the gooroo community to respond. Some of the questions will be familiar, some will be unusual, and some will be bizarre. Hopefully, we will all learn through the process. So let’s begin…
BACKGROUND
The mother of an exclusively breastfed two-month old baby (her first) would like to know how to prevent formation of a fistula following incision and drainage of a breast abscess.
QUESTION
“One drain site we are hoping will heal closed and the other site we are trying to keep open with a cotton swab to allow the abscess is completely drain. My surgeon is taking a “wait and see” approach for two weeks. If healing is not progressing appropriately, he thinks I may need to wean in order to prevent a fistula from forming. Do you have any other possible solutions? Is it better to risk a fistula than to wean?”
ANSWER
Continued breastfeeding is more likely to prevent fistula formation than cause it. Often there is short-term drainage through the incision—first blood and then milk. If you continue to breastfeed, as the inflammation goes down, the milk will exit through the milk ducts more and more, so less and less will come through the drainage or incision site. More often, epithelial growth factors and cellular components in the milk speed the healing process when compared to that of other types of abscess, so the wound should close faster.
Attempting to wean during this process gives the milk no choice but to exit through the incision site. Since the milk has this alternate exit route, milk production continues as long as there is milk flow through the incision site. The result is that milk flow is reinforced, so milk keeps the drainage site open, at the same time, the milk encourages the tissue to heal around the opening, so now the opening at the drainage site becomes a permanent fistula.
“The surgical literature that reports fistula formation in lactating women actually shows fistula formation subsequent to weaning. If a mom continues to breastfeed, there will be normal milk flow through the incision site and no fistula formation.” said Tina Smillie, the director of Breastfeeding Resources in Stratford, CT.
It’s important that your surgeon understand the physiology of the lactating breast.
Ok gooroos, now it’s your chance to share your expertise. Just use the “Leave a question or comment” box below.
I have no experience with this, but know of another source that might be helpful when talking with your doc: the Academy of Breastfeeding Medicine’s protocol on mastitis. The section on abscess states: “After surgical drainage, breastfeeding should continue. A course of antibiotics should follow drainage of the abscess.”
The link is http://www.bfmed.org/ace-files/protocol/ProtocolMastitis4rev.pdf
Hi,
I have a question. My granddaughter is having a problem with bowel movements. This started after she was with another toddler in another state who was having some trouble. The Dr didn’t feel it was related - I am not sure. The Dr is finally doing some cultures and told them to keep her away from tomatoes and juice. Her symptoms are - She tenses up and cries really hard when she has to have a movement and then the movement is only a squirt and then she goes through the whole process again as often as 5 times a day. She is also complaining of a “burning” (really red and sometimes with bumps) on her skin. The Dr told them to use molasses a while back, which did help. The movements are not constipation though. She was put on an antibiotic and an anti-fungal topical cream - Dr thought might be strep. That helped only a few days. Now it is back. If it is an intolerance to a food - I don’t feel it is tomatoes or juice (she has very little of these foods) - What other foods could be the culprit? She was breastfed for 9 mo exclusively then on Enfamil. Mom introduced foods slowly and carefully. But, there are food intolerances in the family. Her brother is intolerant to corn (all forms) and I have many food intolerances. Thank you for taking the time to read this and if you can help I would appreciate any info you can give me.
Thanks
Sandy
It is best to talk with your granddaughter’s health care provider, especially if your granddaughter’s symptoms are not resolving or getting worse. The best way to evaluate the cause of her burning skin is to see the skin condition. Since she has a family history of food intolerance (which is different from food allergy) her doctor might suggest that your granddaughter see a pediatric allergist for evaluation.
There are lots of foods that children can react to, but those that are more likely to cause a reaction in a sensitive child are eggs, wheat, nuts, and dairy products. The pattern of her bowel movements may be related to what she is eating or may simply be a pattern unique to her. If she is growing well, I would be less concerned than if her growth was faltering. If her bowel movements continue to be painful, again, it is best to talk with her doctor.