The baby could be using the tongue abnormally, compressing the nipple 
base with the elevated tongue (see Geddes frenulotomy article in 
Pediatrics last year). We've seen the same thing in our study, which we 
just wrapped up. The nipple looks fine when it comes out of the mouth, 
and the latch looks good from the outside too.

This is usually the result of a tongue-tie. It might even be a minimal 
one, which you ordinarily wouldn't think anything of. Once the nipple 
skin is injured, it can become infected. Washing with mild soap and 
water several times a day decreases the chance of nipple infection and 
mastitis.

Catherine Watson Genna, BS, IBCLC   NYC

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