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lllcollective.org.uk
LLL Collective
@lllcollective.org.uk
A La Leche League breastfeeding charity in Great Britain.

More on lllcollective.org.uk

A Scottish Charitable Incorporated Organisation SC053899
The thread got broken here, continue here -> bsky.app/profile/lllc...
Lenny: Advocay is key

- briefing elected members/cabinet on importance of best start in life
- making corporate leadership team aware of how this delivers our strategy
- influence the wider health and care community
- enjoy the opportunity to be positive & hold this up as a model for change
November 19, 2025 at 12:23 PM
Dow: what's next?

- updated BfN guidance Pain: if breastfeeding hurts www.breastfeedingnetwork.org.uk/breastfeedin...
- NICE updated some CKS pages
- education for HCPs & lactation workers key!
- collaborative working, accessible info, clear & consistent messaging

You can be part of this!

End 👋
Pain: if breastfeeding hurts - The Breastfeeding Network
Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before co...
www.breastfeedingnetwork.org.uk
November 13, 2025 at 11:54 PM
Dow: Challenges

- lactation suffers from severe under-investment
- change is difficult, especially of clinical practice
- around 17 years from knowledge gained to being embedded in practice 😭

Getting a clinical innovation into practice Kirchner et al 2019 pubmed.ncbi.nlm.nih.gov/31488332/
Getting a clinical innovation into practice: An introduction to implementation strategies - PubMed
Just as there is a robust science that supports development and rigorous testing of clinical innovations, the emerging field of implementation science is developing new theory-based knowledge regarding a growing portfolio of meticulously tested implementation strategies that seek to improve uptake o …
pubmed.ncbi.nlm.nih.gov
November 13, 2025 at 11:51 PM
Dow: Conclusions
- Candida infection of the nipple or breast doesn't make biological sense, not supported by research

more like to be:
- P&A/pumping trauma
- nipple dermatitis
- vasospasm
- neuropathic pain
- breast dysbiosis
November 13, 2025 at 11:47 PM
Dow: returning to confirmation bias
- lactating woman/parent w nipple changes and/or breast pain
- baby may/may not have oral thrush (usually not)
- nipple or oral swab may/may not be +ve for Candida
- antifungals may seem to improve symptoms for some (often temp)
- BUT /= *infected* with Candida!
November 13, 2025 at 11:46 PM
Dow: Breast dysbiosis/subacute mastitis -> disruption to normal microbiome
- can be caused by hyperlactation, pumping, medications eg. antibiotics
- overgrowth of coagulase -ve Staph forms thick biofilm inside ducts -> shooting pain & blebs

Mammary Dysbiosis connect.springerpub.com/content/sgrc...
Mammary Dysbiosis: An Unwelcome Visitor During Lactation
Mastitis can be an unwelcome and debilitating visitor to breastfeeding mothers. The mammary gland has its own microbiome that can be affected by reduced polymorphonuclear neutrophil recruitment during the first 3 months postpartum, as well as the receipt of antibiotics during the last trimester of pregnancy. This can leave the breast vulnerable to pathologic bacterial overgrowth. Mammary dysbiosis is a process whereby the population of potential pathogens increases at the expense of the normal mammary microbiota. Multiresistance to antibiotics plus tricky evasion techniques engaged in by bacterial agents can result in microbes that are elusive to antibiotic therapy. Therefore, new strategies are needed for the treatment of this threat to continued breastfeeding. Bacteriotherapy, targeting harmless bacteria to displace pathologic organisms, is an emerging therapeutic intervention that uses probiotics instead of antibiotics. Once more high-quality clinical trials of strain-specific probiotics have been conducted, bacteriotherapy may move into mainstream mastitis treatment.
connect.springerpub.com
November 13, 2025 at 11:43 PM
Dow: Neuropathic pain
- nociceptive pain [frm physical damage to the body] vs neuropathic pain [frm nervous system not working correctly]
- differing pathology
- differing symptoms
- differing management

See nerohttps://physicianguidetobreastfeeding.org/mythbusters/horrible-nipple-pain-dnss-dmer/
DMER and Nipple Nerve Pain - Physician Guide to Breastfeeding
DMER (Dysphoric Milk Ejection Reflex) is a condition that generally causes excruciating nipple pain an/or icky feeling when breastfeeding and pumping.
physicianguidetobreastfeeding.org
November 13, 2025 at 11:37 PM
Dow: so if not thrush, what is it?
-> start with P&A and/or pumping assessment

Nipple Dermatitis
- can affect anyone
- risk increased postpartum to pro-allergenic substances eg. lanolin
- equipment causing maceration eg. shells, cups
- mechanical trauma eg. pumps, dysfunctional suck
November 13, 2025 at 11:32 PM
Dow: why does it matter anyway?
- untreated pain
- psychological distress (esp around hygiene measures)
- unnecessary medication
- premature cessation of lactation

wrong diagnosis
wrong treatment
ongoing symptoms
November 13, 2025 at 11:20 PM
Dow: what about nipple swabs?

Do NOTE swab nipples to diagnose infection (only exception is for suspected herpes simplex virus HSV)
- both intact skin & wounds will always have microbes
- nipple swabs may be +ve for Candida because of oral transmission
- skin/wound infection is a clinical diagnosis
November 13, 2025 at 11:19 PM
Dow: oral thrush cont.

From Oral Candidiasis: A Disease of Opportunity pubmed.ncbi.nlm.nih.gov/31963180/:

"changes in the host microenvironment can promote the transition from one of commensalism to pathogen"
Oral Candidiasis: A Disease of Opportunity - PubMed
Oral candidiasis, commonly referred to as "thrush," is an opportunistic fungal infection that commonly affects the oral mucosa. The main causative agent, <i>Candida albicans</i>, is a highly versatile commensal organism that is well adapted to its human host; however, changes in the host microenviro …
pubmed.ncbi.nlm.nih.gov
November 13, 2025 at 11:17 PM
Dow: Oral thrush

- definitely a thing! ...but hugely over diagnosed
- up to 80% of the general population carry Candida in their mouth as a commensal
- Candida isolated from nipples is v likely to have come from infant's mouth
November 13, 2025 at 11:15 PM
Dow continued! So if they work, why can't we just use antifungals for breast/nipple pain?

- 7% of Candida found in blood samples in the US are now resistant to fluconazole
- over-use of antifungals is a major contributor to this issue
- we need antifungals for our sickest and most vulnerable
November 13, 2025 at 11:13 PM
That's it from us - we'll try to finish the thread about @drnaomidowibclc.bsky.social's presentation later! 👋
November 13, 2025 at 4:14 PM
Woods: think of the conference like being at the top of the mountain that Shereen and Anna both spoke of yesterday. Take in the view

Next year the conference will be back online. See again you in person in two years! #BFConf
November 13, 2025 at 4:13 PM
And on day 2
@vicky-thomas.bsky.social, @jameskinross.bsky.social, @philbakernz.bsky.social, @drnaomidowibclc.bsky.social, Illiyin Morrison, @ndzitina.bsky.social, Matt Lenny from North Somerset Council, Gill Thomson & Victoria Hall Moran & Anne Woods & Shereen Fisher #BFConf 🙏🏿🙏🏾🙏🏽🙏🏽🙏🏼🙏🏻
November 13, 2025 at 4:04 PM
Thanks to all the brilliant speakers & chairs 🙏🏿🙏🏾🙏🏽🙏🏽🙏🏼🙏🏻
@profamcf.bsky.social, Philip Goodwin from
@unicef-uk.bsky.social, Anna Byrom from @all4maternity.bsky.social,
@aaloysius.bsky.social, Vicky Sibson from
@1stepsnutrition.bsky.social Yafa Ajweh & Reem Al Soufi from GINA & Brittal Stordal #BFConf
November 13, 2025 at 4:02 PM
Final remarks now from Anne Woods, Deputy Programme Director, UNICEF UK Baby Friendly Initiative #BFConf

Reflections on the Conference > 1100 delegates, applause for everyone who have achieved or are working towards accreditation 👏🏿👏🏾👏🏽👏🏼👏🏻
November 13, 2025 at 3:59 PM
Thomson: watch this space! You will hear about this work, there will be lots about it. They may be back next year to present the results
November 13, 2025 at 3:54 PM
Thomson: other areas to look at?

- unpacking negative experiences - parent and staff perspectives
- skin-to-skin - lack of parent-related interventions
- conversations on close & loving relationships
- supply insufficiency
- colostrum harvesting
- social media
November 13, 2025 at 3:52 PM
Thomson: on mixed feeding cont.

- pumping - downsides time-consuming, painful, demoralising

- dangers/risk to milk supply
November 13, 2025 at 3:51 PM