I present this case for your ideas with permission from the mother:
This is a 23 y/o G2P2, with a six week old baby who appeared about 12 days
ago in my clinic with what seemed to be a classic case of thrush. Good
weight gain (great actually) in baby. His tongue was white, he was fussy,
eating constantly, mother beginning to complain of signs of deep breast
pain, and her nipples were red and shiny. The pedi. put the baby on
Nystatin and a CNM put the mother on Fluconazole. In a couple of days the
symptoms began to dissipate in both of them. Then they came back in the
baby, more whiteness on his tongue and he was getting fussier. I suggested
Gentian Violet for both of them and they did it with another temporary
period (a couple of days) of relief. Yesterday the baby was back to see the
Pediatrician and she put the baby on fluconazole, although trepidatiously,
because she had never done it before. But after looking it up in several
references she did it. The CNM renewed the fluconazole for the mother.
Today the mother is saying the baby was terribly fussy last night, super
gassy and she reports, "the top of his gums and some parts of his mouth are
somewhat like [her] nipples were" (that is, red and painful). I told her
that it does take time for fluconazole to work and that the baby has been on
it less than 24 hours.
I asked the Pediatrician yesterday to culture the baby's tongue, but she
declined. Now I really want to know what this is, because it looks like we
may not be treating what we think we are, even though it is CLASSIC in its
presentation!
She has also asked me if she can squirt her milk into the older brother's
ear b/c he seems to be developing an ear infection. I told her not to,
until we find out what is causing these symptoms.
Any ideas? Thank you!!!!
Lizabeth J. Berkeley, MPH, CHES, IBCLC
Department of OB-Gyn
Texas Tech Health Sciences Center
4800 Alberta Ave.
El Paso, TX 79905
I have obtained consent from the mother involved to transmit this report to
her health care provider(s), as required by the International Board of
Lactation Consultant Examiners (IBCLE) Code of Ethics, and the International
Lactation Consultant Association (ILCA) Standards of Practice.
This report contains information which falls under the privacy sections of
the Health Insurance Portability and Accountabliity Act of 1996 (HIPAA).
When you read it, you will see personal information and details about a
mother and her baby.
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