After previously reading the interesting posts on the upper lip frenulums
earlier this year, I had wondered to myself- "have I seen it?"  "would I
see it?" "can I have missed it?".....Answers would have been "maybe, maybe
and maybe," however, today was a situation that would enable me to answer
"yes, yes and not this one!"

Second time mom, with 10 day old, presented with getting worse symptoms of
breast/nipple pain--hard to decide which over the phone, no wounds on
breast or nipple. She came over for a feed, and when this baby opened his
mouth it was quite an interesting sight.  Picture an upper gum line with a
little rectangular approximately 1/8th+ inch wide, 1/16+ inch high (get out
your measuring sticks!) piece missing in the very center. Picture the
inside edges of this cut-out  subtly swinging in just a bit to make points.
 Lifting the upper lip, you would see from the normal location of the
often seen sucking blister, a little tube sort of shape following from lip
through the little missing area to the palate.  Palate was a little higher
than average.  The mom describes that her pain comes with every
compression, along the top of the latch and to her it feels like the baby
is biting her.  To me, it would seem that her breast is being compressed
into the split area, as well as pushed into the palate.  The baby  can
flange his upper lip, and it seems like most of the pressure from the tight
frenulum is across his gum ridge.

Any comments?  Any suggestions for pain relief? Interventions? She is
willing to work this through; we talked about varying positions to put
pressure on varying parts of the areola, but I am wondering if this is
going to be one of those tincture of time situations.

Any suggestions would be welcome!

Karen Foard, IBCLC,  State College, PA