I had a case recently where a mother had extreme sore/cracked  nipples.  This 
was her second baby and she did not have these problems with  her first.  
I saw her at 5 days postpartum.  Both nipples had cracks on the tips  and one 
nipple the crack was larger and deeper.  Observing a breastfeeding,  the 
positioning and latch appeared correct and deep but the mother was in  extreme 
pain.  Baby was transferring milk and had started to gain  weight.
I examined the baby's mouth after the nursing and found a bubble palate and  
a short frenulum.  The frenulum did not attach to the tip of the tongue nor  
was it a posterior tongue tie.  I would describe it more in the  middle.
The mom had already picked up a Rx for the APNO and would start that right  
away.  I reviewed more of an asymmetrical latch, trying a nipple shield,  
pumping for a couple of days while nipples healed, and clipping the  frenulum.  I 
gave her an article from ABM on frenulums to read over on  making her decision 
and than discuss this with her pediatrician.  
Mom called me back the next day and told me that her mother said she was  
tongue tied and so was she.  Both had tongues clipped while they were  babies.  
The mom meet with her pediatrician who initially blasted her with  any idea of 
clipping a tongue even though she told him both she and her mother  were 
clipped.  The next day he called her back and had made a referral to  an oral 
surgeon at Children's hospital.  
At that visit the oral surgeon made the decision that the frenulum should  be 
released so numbed the area and than used laser to free the frenulum.  
The mom went on to nurse and had much less pain.  She told me there is  a 
small white spot where the laser had freed the frenulum.
I know of only one other case where laser was used but that was for a very  
fibrous frenulum and was done in the OR.  
Have others seen this approach?  Any comments?
I am happy that everyone in this case came out winners.
Ann Perry, RN IBCLC
Boston, MA



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