I have permission to post. I need help badly. I have a client who can't stop crying. It's making me want to cry not knowing what's the missing piece. Mom called yesterday. She had seen a LC 3 times during the week for on going nipple pain. Baby is almost 6 weeks old. No birth trauma. I am thinking, no problem, I can guess that it is an undiagnosed tongue tie or lately my new things to find in the baby are tight labia frenulums.

Mom has no nipple damage but she complains mostly of a "rubbing" sensation from the tongue on the lower part of the nipple.  Pain level is usually an 8.   We did skin to skin, baby led latching. Baby opens beautifully. Tongue down, lips open and wide. But at the breast, you can't get the top lip to stay curled up and the bottom lip is shallow. Other times, the lips looked puckered as if he is just kissing the nipple. Repeated flipping lips out go unsuccessfully. After baby comes off, you see the flatness of the nipple on the bottom but round on top of the nipple. Baby has the best lips and a large mouth. I did a suck assessment and a look around the baby's mouth. An obvious labia frenulum however, the lip can curl up, but does not stay. It isn't a tight frenulum meaning that the the lips are long and the membranes attaches from the upper gum to the lip and then there is still lip skin higher above the membrane. Does that make any sense?  The palate seems fine. Thank goodness. Then I see this tongue come out pass the gums but when the baby cries you see the tongue recede into the mouth and low and behold a membrane under the tongue but it is really receded and thin. So you won't see the frenulum unless you are really looking and just at the same time the baby brings the tongue up briefly. The tongue is also flat, and not curved. 

This tongue can come out, it just doesn't stay too long. Baby slides down from the nipple if mom does not hold baby very close. Her technique is great. We tried several positions and nothing made any difference when it came to reducing pain. Baby also chomps at the breast. He is aggressive when nursing, not ever relaxed but mom claims it is because we are working him.  When I had him suck on my finger, he wasn't chomping as much I see at the breast. Overall suck wasn't a barracuda nor too weak. 
 
This mom is also a pediatrician and shes not convinced yet that it is a tongue tie because she has clipped alot she said and she doesn't see where she would clip this tongue. She saw the membrane that I showed her but she is not confident that there is enough tissue to clip.  Maybe it isn't a tongue tie.  She just has all the classic symptoms. That is why I am asking and pleading for answers from you wise women. 


Thank you, 
Julie IBCLC

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