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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