Hello, I have permission to post on a Mum with a significant crack (more
like a skin tear or rip) at the base of the nipple on the outer aspect,
approx 1/2-1cm length and a crack on the right nipple tip as well as
abrasion to the left nipple tip.  Baby is 3 weeks old, seems to have a "big
tongue".  Tongue hunches at the back, somewhat asymetrical but not too
much.  No visible tongue tie but I am wondering re a posterior tongue tie
though I would have expected the tounge to be flatter and more tethered to
the base rather than humping.  I have little experience with spotting
tongue ties but this baby's tongue is obviously interfering with getting
the nipple deep into the mouth.  Baby is healthy and is thriving on mums
oversupply  but the risk of poor intake increases as Mum's supply moderates.

Baby born vaginally with midwives, short (5 hour) labour, primip, no meds
but fast labour.  Mum noted no moulding of head when born.

What I found fascinating was the babies lower lip after feeding, - across
the length of the lower lip were a series of blisters, almost joined into
one large blister.  I am used to seeing a blister in the middle of the top
lip but never across the whole lip like this.  It was noticeable as a
dryish blister when I arrived several hours after a feed but was very
significant, a blue/grey colour after the feed.  Lower lip were flanged out
during the feed, chin was tight and no matter what we did Baby did not open
wide (though does when crying/yawning/etc) and took in only nipple each
time.  Mum is at her wits end.  I am fairly new to being an IBCLC (LLL
Leader for 8 years) and have not encountered anything like this.

My suggestions were an assessment by Jack Newman who is fairly local to us,
consider CST and keep working with baby to get mouth open and tongue
down.  Pumping from cracked side to let some healing take place and finger
feeding if necessary.

Thanks in advance for any thoughts.  I have looked in the archive and have
not seen anything on this type of blistering.

Gwyn Treharne, RN, IBCLC, LLLL
www.simplythebreast.ca

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