Oral scald injury misdiagnosed as oral thrush in a newborn

A neonate with a history of a brief resolved unexplained event presented to the emergency department with white oral plaques initially diagnosed as thrush and treated with nystatin. He subsequently developed progressive feeding difficulties and respiratory distress requiring supplemental oxygen. Despite treatment with fluconazole and supportive care, symptoms persisted. Multiple swallow studies revealed frank aspiration, delayed swallow initiation and poor oral motor control. Diagnostic investigation, including MRI brain and flexible nasal laryngoscopy, revealed no structural anomalies. A breakthrough occurred when nursing staff were notified that the infant had been bottle-fed hot milk prior to symptom onset. The diagnosis of oral thermal burns leading to dysphagia and aspiration pneumonitis was made. With multidisciplinary therapy, swallow function improved and the infant transitioned to full oral feeds. This case highlights the importance of maintaining a broad differential when evaluating common neonatal findings and demonstrates the potential complications of overlooked thermal injuries in this population.