Hi all,

Two problems over the last two days...

1.  Mom of 2+ month old baby.  Bf went wonderfully the first 4 weeks.  She
introduced a supplementary bo of Sim with iron at that point (on a Friday).
 By Monday, the grandma and her sister thought they saw thrush in the baby's
mouth.  Peds prescribed Nystatin (without seeing the baby).  Started on
Tuesday.  Friday mom goes in to see her doc, nipples slightly red & slightly
sore.  Her doc puts her on Nystatin cream.  Nipples get progressively worse,
as do white patches in baby's mouth.  Continue treatment.  Stop treatment for
baby for a couple of days, but patches continue, so go back to treatment.
 Nipples getting more sore, so mom gives more formula and less bf.  By the
time I saw her, she had been using Nystatin cream for a month & baby on
Nystatin susp. for a month.  Still has a couple of white patches back of
mouth.  this is first time mom has been seen.  I have NEVER in my life seen
nipples that looked this bad.  The entire areola is excoriated & weeping
yellow gunk.  Bright deep red.  Swollen.  Looks as if you touch it the skin
will come right off -- some of the skin is already off.  Looks to me like a
contact derm; I recommended seeing a dermotologist immediately and stopping
the Nystatin -- I don't think it is thrush.  Looks like an allergic reaction
-- to the Similac.  Is that even possible?  Is the juxtaposition of giving
the formula and baby getting white patches just a red herring?  (In this
case, a white herring).  Could it have started as thrush and then progressed
to something else?  It could be an allergic reaction to the preservatives in
the cream, I suppose.  (She has no other history of allergies, either herself
or in the family).  Baby had no diaper rash, no antibiotics, mom had a yeast
infection well over a year ago.
Every time mom called someone, (i.e. other LCs), they told her, "You are
doing all the right things, just keep it up."

This is a plea to NOT diagnose over the phone!  Also, it is way out of my
league -- needs to go to someone else which is why I sent her on to a derm
(can't go this weekend, hopefully early this week).  Any ideas?

Second mom I saw -- girl baby 6 days old has never latched on.  Primarily
screams at breast -- to point where she holds breath & turns (almost) blue.
 Mom had C-Section after long labor; light mec staining; baby had cords
examined with laryngoscope, and 1 1/2 to 2 hours later was put to br where
she screamed immediately, backed off, and refused to nurse.  This happens at
every feed.  Mom pumping, and has tried med droppers, but would rather use a
bottle.  I was totally unable to get baby to latch on using all the tricks of
the trade.  Tongue short but can come over gum line; baby opens mouth with
tongue in position and then sits there.  Second try, just screams.  Looks
like oral aversion, though she will take a finger eagerly & a bottle.  Won't
even latch on to nipple shield.  (Yup, I confess, I tried it).

I've recommended that babies not be put to breast immediately after having
cords examined or rough suctioning, but be cuddled & snuggled until baby
showed signs of wanting to go to br.  I wouldn't have thought 1 1/2 hours was
too short a period of time, though I'll admit this little punkin looks
smarter than the average bear.  She is SO alert!  I recommended mom back off
on "trying" to brfeed for 24 hours, but spend most of her time with baby skin
to skin until baby shows signs of wanting to go to br.  Then go gently...
 Moms a pedi ICU nurse, so handles baby well; positioning good, comfort level
with baby good, but admittedly frustrated.  Any other suggestions?

Jan Barger, in Wheaton where it is sunny and the 10K Run for the Cream of
Wheaton is just ending outside my office windows.  And where daughter Torrey
graduates from high school tomorrow!  And where, of course, it is supposed to
rain this afternoon & all day tomorrow -- probably right in the middle of the
open house.  Sigh.