Hi Julie:

Your description suggests the infant's problems are anatomical.  A wise
friend of mine always says, "If you find one anatomical problem, look for
three."  Mostly there won't be three, taking it literally, but what she is
saying is that an anatomical problem may not happen on its own.  You've
mentioned three:  A short, flat tongue; a high palate that looks unusual;
and an upper lip that doesn't flange out. (Good, thorough work, Janet,
checking for a tight labial frenulum.)  All of these seem to be midline
defects, which are often associated with tongue-tie.  The bruising is like
what I sometimes see when a baby has a tongue that won't protrude enough,
and the mother makes supreme efforts to get the best possible latch.  Then
bruising appears.

I'd really like to see that short, flat tongue, and know the family history.
Could it be one of the variations of a posterior tongue-tie?  Is there
anyone in your area experienced in this who could make an assessment whether
it is, and whether clipping is appropriate or not for this baby? I know you
said the parents weren't interested in any minor surgical procedure, but
some change their minds when they have time to think.   

A further comment, irrespective of what the situation is with this baby.
Amazingly, parents who are against snipping for feeding difficulties, or for
potential speech difficulties, may be more upset at the idea that their
child won't be able to lick an icecream!

Personal note:  I had a lovely surprise yesterday when my younger son,
daughter-in-law and two grandchildren arrived from Sydney yesterday.  A
complete secret.  They are here till tomorrow. 

Virginia
Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Honorary Research Fellow
School of HPRC
The University of Queensland, QLD 4072
Australia

From:    Julie Johnson wrote:
I saw a 3 week old infant.... He is gaining weight like a weed. But mom
complains of sore nipples. No = matter the position, and we tried everyone
imaginable, nothing feels =
better. There is a little bruising on the underneath the nipple. That is =
the only visible sign of damage.... = Her pain is 7 out of 10. He has a
short, flat tongue, a funny looking high =
palate with two ridges on both sides of the roof. I can not get his top =
lip up. It is always curled under. On appearance he does not appear to =
have a tight labia frenulum unless you look at the latch and try to get =
that lip up and out but it will not. He chomps the entire time. When I put =
my finger on the sides of his gums to try to break his suction, the tongue =
is right there however, his gums are also tight. There are no clicking =
noises. There is no milk dribbling out of his mouth as you see in tongue =
tie babies who can't handle the bolus. He does not fall off the breast. He =
latches and he does not want to be taken off. He loves the breast. Mom is =
dedicated but I always feel like I want to fix this situation right age =
... If this is a posterior tongue tie the parents have no interest in
getting it clipped.

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