This had been a trying week for me. I have been getting some pretty tough
cases in the office. I am presenting two of the most outstanding ones below.
One as a warning the other for learning.

Case one:
Warning: Gentian violet causes ulcerations of the mouth.

The mother of a 2 month old baby girl called me because her baby was suddenly
refusing the breast for the last 24 hours. The child has never recieved any
bottles or a pacifier.
Mom was *afraid* to tell me that the baby had a blister on her tongue.
Apparently she had taken the baby to the pediatrician who accused her of
burning the inside of the baby's mouth with a hot bottle. Asking her *Are you
SURE that this baby has never been given a bottle? I have only seen this when
a mother puts a hot bottle of formula in the baby's mouth* Mom was very
upset.
On examination I noted an irregular shaped ulceration about  2-3 cm in
diameter in the center of the tongue near the tip. The area was white in the
center and very red around the irregular edges.
When mom went to put baby to the breast I noticed that her nipple was purple.
Upon questioning, she said that it was left over from  gentian violet. She
had been painting the baby's mouth twice a day for 5 days with gentian violet
(as the ped told her to do) for thrush. Baby refused to latch on--screaming
in protest. I  got one of our MD's to look at the baby's mouth. He assured
mother that the ulceration was from the gentian violet. A burn from hot
formula would be further back in the mouth. He explained that this was not
her fault, the mouth would heal quickly and the breast milk would help
prevent any infection. (I'd like to bottle this doctor!)
We got mom's MER going--expressing directly into the baby's mouth, after a
few swallows baby latched on and nursed calmly for almost an hour. Mom cried
tears of joy (I cried with her too.) I will re check baby's mouth on Friday
and let you know how the healing is progressing.

Case Two: *Stuck tongue* one use for a pacifier
I recieved a call from the mother for a breastpump because she was engorged.
(It's not my policy to give out pumps for engorgement) She and her 3 day old
son met me that afternoon in the office. Baby had lost greater than 10% of
birth weight and was down from 6# 9 oz to 5#2 oz. He was jaundiced. He was
still voiding 4 times per day but had not had a stool since 1 mec. stool
after birth. We softened mother's breast for latch on with an electric pump.
Baby was put to breast and appeared to be sucking and swallowing but there
was an odd noise-- kind of a slurp sound.  The baby had mom's nipple below
the his tongue and he was widly sucking his tongue (Apparntly the swallows
were merely saliva.)
On oral exam: it was IMPOSSIBLE to insert a gloved finger on top of the
tongue. With some gentle prodding I was able to get my finger on top of his
tongue. Howeve,r he was trying to flip his tongue over my finger. I
encouraged the tongue down and forward and gave a few drops of milk as a
*reward*. This was a very difficult process because the baby would
continually try to get his tongue back to the palate. Using an orthodontic
nipple on the bottle of pumped milk I slid it in on top of my finger and held
the bottle nipple firmly against the palate. Even with the bottle there was
an extreamly strong thrust against the bottle as he tried to get the nipple
below his tongue. I sent the mother home with a pump, bottle and a pacifier.
The idea was to FEED THE BABY and break the habit by not allowing the baby to
suck on his tongue.
I saw her 18 hours later. Baby had gained 2 3/4 oz and had 2 stools still
meconium. The tongue was actually coming to the floor of the mouth when the
lips were stimulated-- but he would maneuver mom's nipple below his tongue. I
tried a nipple shield and viola success. Mom could still feel his tongue
trying to get on top of the shield but he settled down with the MER and
gulped loudly with mom's abundant supply. I told her to continue with the
pacifier between feeds, use the shield only if he wasn't latched right (mom
feels a pinch when it's wrong and a pull when it's right) and to use the pump
after feeding to keep supply up. I will see this couplet again on Friday and
let you know how it goes.


Any ideas or input for these two moms?
Marie Davis