Breastfeeding Medicine

Dr. Punger is a native of Long Island, New York. She completed High School, College and Medical School in Georgia. She met and married Dr. Coquelet (from Lima, Peru originally) during residency. Together they moved to the Treasure Coast and were both employed in Martin County for eight years. Too ambitious for employed urgent care work which limited the impact she can make on the breastfeeding community, she took a 'sabbatical' in NW Georgia and returned to the Treasure Coast a year and a half later to private practice.

When her first son was born in 1996, Dr. Punger found that breastfeeding came fairly easy, but was distraught at how many mothers had problems with nursing, receive wrong information, and unnecessarily weaned. As she became involved with the breastfeeding community locally, she realized how her pediatric and obstetric medical training encouraged her to support breastfeeding, but how little had it actually prepared her to help breastfeeding pairs when problems arouse. However, with access to the entire body of medical literature and help from the La Leche League(LLL) and attending the LLL Medical Associates Annual Conference twice, she soon found she could be a resource for mothers having breastfeeding difficulties.

Besides being a Fellow of the American Board of Family Practice, Dr. Punger became an International Board Certified Lactation Consultant (IBCLC) in 2000. She has been a member of the Academy of Breastfeeding Medicine and a La Leche League Medical Associate since 2000. Through membership in these professional organizations, she has 24/7 on-line access to breastfeeding experts around the world and can seek opinions and references quickly for special situations. Locally she chaired the local Treasure Coast Breastfeeding Task Force for two years. She attends local LLL meetings and has been a member of Florida Lactation Consultation Association for five years. She appreciates how the birth experience can affects breastfeeding and is actively involved with pregnancy support groups. She writes and photographs for local and international birth and breastfeeding publications.

As breastfeeding rates continued to climb and is continued to be increasingly endorsed by WHO, AAP, AAFP, and other major organizations, the need became apparent for a specialty devoted exclusively to the unique needs of breastfeeding mothers and their babies. By established Coquelet & Punger Family Medicine in 2004, Dr. Punger can pursue her interest in helping breastfeeding dyads, free of the politics of an employed position, yet continue out-patient Family Medicine. She is the only Family Physician in Florida who is also an IBCLC and she can uniquely treat the breastfeeding mother and baby as a pair.

She has three homeschooled sons. Her experience breastfeeding her three boys include employment and pumping, nursing through pregnancy and tandem, tongue-tie and donating her own breastmilk to a milk bank.

Specializing in:

Maternal breastfeeding problems

sore nipples

• cracks

• rashes

• abrasions

• bleeding

• infections

• other causes

mastitis

• non-infectious

• infectious

• breast abscess

low milk supply

• diagnosis and treatment

too much milk/overactive letdown

• diagnosis and treatment

medical problems - treatments that won't interfere with breastfeeding

• acute illnesses

• allergies

• hypertension

• diabetes

• thyroid

• migraine headaches

• contraceptive options

• dental/surgical anesthesia

medication questions

• seizures

• rheumatologic problems

• other

postpartum depression

• medical treatment

• non-medical treatments

Infant breastfeeding problems

slow weight gain/failure-to-thrive

• poor milk transfer

• other

jaundice

colic

gastroesophageal reflux

sensitivities to foods in maternal diet

infant medical problems

congenital anomalies

• Down Syndrome

• heart defects

• cleft lip or palate

• other

prematurity

• mom pumping

• teaching baby to feed at breast

tongue-tie

nursing strike

Special situations

pumping problems

• uncomfortable

• decreasing supply

Prenatal preparation

• birth plan to optimize breastfeeding success

• individual breastfeeding class

• why breastfeeding failed with last baby

nursing through a pregnancy, tandem nursing and multiples

returning to work or school

relactation - returning to breastfeeding after stopping

induced lactation for adoption

prescriptions for banked breastmilk

medical clearance exams for donating your own breastmilk

weaning verses nursing in to the toddler/preschool years


To prepare for a visit:

Because breastfeeding involves both mother and baby, whenever possible, both will be examined. Mother will have vital signs checked, a breast examination to assess physiologic function (different from an exam that checks for cancer), and other exams as appropriate. Baby will have measurements taken, including a precise weight, a general checkup, and a specific oral motor checkup. Whenever possible, breastfeeding will be observed to determine the exact nature of the problem and how best to help correct it. Occasionally, a "test weight" may be done if a precise measurement of breast milk intake at the breast is needed. If a test weight is needed, it is important that the baby's diaper or clothing NOT be changed between the two weighings. Same day appointments are often available for emergencies.

Bring a baby blanket. Bring a drink and snack for the nursing mother. Bring your pump, SNS, pumped milk or supplement as appropriate. Avoid feeding your baby formula for four hours prior to a visit. (We can't teach a full baby how to latch). Neither mother nor baby should dress in one-of-a-kind, hard-to-wash clothing. Baby should wear something easy to remove. We don't want to stain it with blood or a gentian violet application for example. Bring in an extra diaper. If at all possible fill out your new patient forms ahead of arriving to the office and arrive early. This will maximize one-on-one time with Dr. Punger. She allots at least 45 minutes or more of time for dyads. Be familiar with the location of the office. We want our time with you to be quality time. A spouse or grandmother is encouraged and welcome, however, the whole clan is often proves to be non-productive and overwhelming to the dyad.

Dr. Punger keeps a digital camera in the office to take photos for documentation, education, publication, or sometimes just plain fun. Permission is requested first as she respects your privacy and modesty.

Payment policy -- As with any office visits payment is due at the time services are rendered unless previous arrangements have been made (including co-payment for both mother and baby). Coquelet & Punger Family Medicine is happy to file your insurance for you, or we can give you the information to do so yourself. We do accept straight Florida Medicaid and most other health plans. Occasionally services are not covered by individual health plan policy and you will be responsible. We make all attempts to file it in a way that will be most likely consistent with coverage. We are required by state law to charge applicable sales tax on any personal supplies that you purchase. For your convenience, we accept cash, personal checks, VISA and MasterCard.

Breastfeeding difficulties won't last forever. Your persistence will have its rewards. A year worth of formula and supplies are estimated to cost $1000 or even more if specialty formulas are used. A family investing in an office visit and even a pump still comes out ahead.



All too often we hear that a mother stopped breastfeeding or supplemented for medical reasons. When Dr. Punger reviews the situation, she finds the weaning often occurred because of misinformation. Be informed!

A breastfeeding visit does not substitute or equal a well-child check or well-woman. You will be scheduled for a follow-up or referred back to your primary care provider as appropriate.



Same day appointments are often available. Referrals from health care professionals and self-referrals are accepted.