Differential Diagnosis for 1 Month Old Female with Feeding Difficulty and White Patches on Tongue

• Single Most Likely Diagnosis
  • Oral Thrush: This is the most likely diagnosis given the presence of white patches on the tongue, which is a classic sign of oral thrush, a fungal infection caused by Candida. It's common in infants, especially those who are breastfed, as the fungus can be transmitted from the mother's skin or nipples.
• Other Likely Diagnoses
  • Milk Allergy or Intolerance: Although less directly related to the white patches, difficulty with feedings could suggest an allergy or intolerance to milk proteins, which might also lead to oral manifestations or discomfort that could be mistaken for or contribute to feeding difficulties.
  • Gastroesophageal Reflux Disease (GERD): This condition can cause discomfort during feedings, leading to poor feeding. While it doesn't directly cause white patches on the tongue, the discomfort could lead to less effective feeding, and GERD is a common issue in infants.
• Do Not Miss Diagnoses
  • Congenital Syphilis: Although rare, congenital syphilis can cause a variety of symptoms, including oral lesions. It's crucial to consider this in the differential diagnosis due to its severe consequences if left untreated.
  • Herpes Simplex Virus (HSV) Infection: Neonatal HSV can present with oral lesions, among other symptoms. Given the potential severity of HSV infections in newborns, it's essential to rule out this diagnosis.
• Rare Diagnoses
  • Leukoplakia: A rare condition in infants, characterized by white patches on the mucous membranes that cannot be rubbed off. It's less likely but could be considered if other diagnoses are ruled out.
  • Histoplasmosis: A fungal infection that can cause oral lesions, though it's very rare in this age group and would typically be associated with systemic symptoms or exposure history.