In my experience, when a mom has pain with one baby after another, there 
is often a familial anatomical variation that is responsible for the 
painful feedings.  Sometimes it's a short or retroplaced mandible, 
others it's a tongue tie (sometimes it's both at once, making it a 
particularly tough situation). Take a good look at all the infant's 
tongue movements.  She should be able to : elevate her tongue tip to the 
palate with her mouth at least a half maximal gape; lateralize her 
tongue tip to at least where the canine teeth will be, without twisting 
the body of the tongue; extend her tongue tip to the center of the lower 
lip without the tongue tip rolling "under" the body of the tongue.  If 
any of these are not happening, there is some restriction going on.
When you watch the baby suck, does she overuse her upper lip?  If so, 
the latch may be shallow or she might have a tongue tie.  Does the 
breast get pulled in and out of the mouth during sucking?  That's a sign 
of tongue tie.  Does mom report bumping of her nipple with each suck?  
That's a sign of posterior tongue elevation, which is also the result of 
tongue tie, confirmed on ultrasound by Donna Ramsay, PhD.  Does mom feel 
chewing when the baby sucks?  That can be from a short jaw, short 
tongue, or both short jaw and tongue tie that causes the tongue to 
retract during sucking (it might look perfectly normal at rest...these 
are the sneaky ones).  More head extension so the babe can bring in the 
short jaw or tongue to the breast is helpful, but might no do the whole 
trick if there's a posterior tongue tie too.  If there's any dimpling of 
the cheeks, and especially if the nipple is creased or flattened as soon 
as the baby releases it, the latch is shallow.  Some babies have thier 
mouths wide open but their tongues up at midmouth when they latch, so it 
looks good from the outside, but the tongue tip is right against the 
base of the nipple injuring mom.  In this case, there will likely be 
some damage to the nipple/areolar junction as well as 
flattening/creasing of the nipple.
Good luck, this poor mom needs it.
Catherine Watson Genna, IBCLC  NYC

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