| I start with local treatment consisting of: 1. Gentian violet (look under that title at the websites below). Once a day for 4 to 7 days. If pain gone after 4 days, stop gentian violet. If better, but not gone after four days, continue for 7 days. Stop after 7 days no matter what. If not better at all at 4 days, stop the gentian violet, continue with the ointment as below and call. Plus: 2. Nipple ointment as below: mupirocin 2% ointment (15 grams) nystatin 100,000 unit/ml ointment (15 grams) clotrimazole 10% (vaginal cream) (15 grams) betamethasone 0.1% ointment (15 grams) The pharmacist mixes it all together and it is applied sparingly after each feeding (except the feeding when the mother uses gentian violet). Do not wash or wipe it off, even if the pharmacist asks you to. You need a prescription for it. Clotrimazole 10% is difficult to find in Canada, and apparently not available in the US. It can be left out if it is a problem to find. Clotrimazole 2% should not be used instead. The addition of any ingredient dilutes the other ingredients and the other ingredients dilute the clotrimazole 2% making it 0.5%. In Canada, Kenacomb (easier to find) or Viaderm KC (less expensive) ointment can be substituted for the above combination. This is used until pain free and then use less frequently over a week or two until stopped. (See Treatments for Problems 1 under �all purpose nipple ointment�). 3. If pain continues and it is sure the problem is Candida, or at least reasonably sure, add fluconazole 400 mg loading, then 100 mg twice daily for at least 2 weeks, until the mother is pain free for a week. If fluconazole too expensive, ketoconazole 400 mg loading, then 200 mg twice daily for same period of time. If Candida resistant, itraconazole, same dose and time period as fluconazole, though Candida actually is less sensitive to itraconazole, generally, than it is to fluconazole. (See handout Fluconazole). Fluconazole is apparently now available as a generic product (therefore less expensive). 4. For deep breast pain, ibuprofen 400 mg every four hours may be used until definitive treatment is working (maximum daily dose is 2400 mg/day). Questions? (416) 813-5757 (option 3) or [email protected] May be copied and distributed without further permission |
| CANDIDA PROTOCOL |
| Here is the way I proceed for "insufficient milk supply" (actually, most mothers have lots, but the problem is that the baby is not getting the milk which is available). 1. Get the best latch possible. This needs to be shown by someone who knows what they are doing. Anyone can look at the baby at the breast and say the latch is good. The accompanying diagram, or the one available at the second website below shows how to get a good latch. 2. Know how to know the baby is getting milk (open-->pause-->close type of sucking). See handout: How to know my baby is getting enough milk at the websites below. 3. Once the baby is no longer drinking, use compression to increase flow to the baby. See handout Breast Compression at the websites below. 4. When the baby no longer drinks with compression, switch sides and repeat. Keep going back and forth until the baby does not drink even with compression. 5. Try fenugreek and blessed thistle. These two herbs seem to increase milk supply and increase rate of milk flow. There is more information on the handout Treatments for Problems 2 at the websites below. 6. In the evening when babies often want to be at the breast for long periods, get help to position the baby so that you can feed lying down. Let the baby nurse and maybe you will fall asleep. Or rent videos and let the baby nurse while you watch. 7. It is not always easy to decide if a baby needs supplementation. Sometimes more rapid growth is necessary. If possible get banked breastmilk to supplement if you can. If not available, formula may be necessary. However, sometimes slow but steady growth is acceptable. The main reason to worry about growth is that good growth is one sign of good health. A baby who grows well is usually in good health, but this is not necessarily so. Neither is a baby who grows slowly in poor health, but physicians worry about a baby who is growing more slowly than average. 8. If it is decided to supplement, the best way is at the breast with a lactation aid. Introduce the supplement with a nursing supplementer (lactation aid), not bottle, syringe, cup or finger feeding. See handout on Lactation Aid at the websites below. Supplement only after steps 3 and 4 above and the baby has nursed on at least both sides. 9. If the baby is older than 3 or 4 months, formula is not necessary and extra calories can be given to the baby as solid foods. First solids may include: mashed banana, mashed avocado, mashed potato or sweet potato, infant cereals, as much as the baby will take, and after the baby has nursed, if he is hungry. 10. Domperidone is a possibility. It is not a panacea. Questions? (416) 813-5757 (option 3) or [email protected] May be copied and distributed without further permission Click Here for Printable Version |
| PROTOCOL FOR ' NOT ENOUGH MILK' |
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