I have an interesting case. Mom called me 5 weeks post partum. Has severe sore nipples and about to quit. During consult, tongue looks great. Extends great. Moves in all directions. No hump, no concaveness. Actually appears normal to me. Latch looks awesome. Does have a high palate but not too bad. There is no "band" under the tongue. The loudest clicker I have ever heard. Mom mentions that baby does great with bottle other than milk coming out sides of mouth. But during let down the baby can't handle the flow. She gulps very loudly and I almost would describe it as having a hard time breathing. I have never seen a baby do this or react to nursing in this way. She does come off after about a minute to take a breath and just goes back to nursing. Mom says she does pull off alot during feedings. 

I got mom in a laying down position to help the milk flow slower and baby would not go for that one. We tried the clutch hold and baby did better but the clicking was still present. When we really try to get baby in deeply, clicking still there but lessened and baby pulls nipple and comes off breast angry. This is usually a very happy baby. Wants to nurse just keeps pulling off and on. 

So, we are now using a shield which takes the pain away and baby has no clicking sounds. Baby appears happy. Mom reports that her breasts appear drained since using the shield. 

So, what is this and how can mom get baby to nurse without shield. She has all the classic symptoms of posterior tongue tie but the tongue appears good. When mom takes the shield away during nursing, severe pain and clicking returns and she has to fight baby back to breast.

Any suggestions? Thanks!

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