I saw a client today who wants to relactate (baby now 6 weeks old)
because her baby is not tolerating formula. She started to breastfeed
after delivery and noticed the baby's lips becoming "very chapped" by
about the third feeding. At the end of the second day that baby's face---
cheeks, chin, had "broken out", and she thought it might be the weight of
her breast so she tried formula. After several formula feeds, the face
cleared up, and each time she tried the breast, he broke out again.

At 2 weeks she quit breastfeeding and went to formula, but now baby is
fretful, unhappy and in pain virtually from one feed to the other; in the
office today he settled only a couple of times, and reacted strongly to
changes of holding/position with extreme irritation.  He also now has
eczema on his face which she has treated with cortisone cream. We laid
out a plan to bring up her supply, eliminated dairy from her diet as dad
is intolerant of milk, tried him at breast (he took the breast briefly,
then began crying again), and decided to go with bottle rather than try
an SNS when he is so extremely sensitive.

Mom just called me back tonight to report that baby has been acting like
he is in a lot of pain when he feeds. He was crying/screaming by the
telephone as we talked, and she told me that she noticed a "blister",
which she then described as a dark red spot on the tip of his tongue
(kind of like when you scald your tongue) with a bump on the side. Baby
did not have this when I saw him this morning, and mom wondered if it
could have been caused by putting him to breast.  (I hope not! Caustic
breasts!) He has been sticking his tongue out a lot tonight, something he
does not normally do.

Blisters remind me of herpes, and when I asked her if she had a history
of STDs she told me that she did indeed and had even had two flare-ups
during the pregnancy that were not reported to the OB.

Only other possible factor-- mom had been using disposable nursing system
with the NUK tip, and I suggested she try the regular long-based NUK to
help baby get used to more in his mouth.  She tried for one feeding and
the start of one more, and he resisted so much that she did go back to
the usual.  However, she says he continued to act fretful on the usual
nipple too, so I would hope that the brief change in nipples would not
have been the cause of the sore tongue tip.

So--- does this presentation sound like herpes or something else?  Latex
allergy? Dermatitis?  (With the latter two I would think more of the
tongue would be affected).

I recommended that she run this by her ped tomorrow, or call even tonight
if he continues to act in extreme pain. Also asked her to take his
temperature.   Anyone seen something like this before?

-Lisa Marasco, BA, IBCLC