I am following the thread of the infant with oral herpes lesions with
interest.  I recently saw a mother with her second baby.  I had helped her
with her first several yrs ago, and knew she was a "proven producer" and had
good skills.  Baby wouldn't latch in spite of ok birth, rooming-in, no
bottles.  I saw them on Day 4 to help manage engorgemnt and assess baby and
to try to facilitate latch.  I observed a frenulum attached at the
tongue-tip and tight lingual frenum on upper lip. I did not observe tongue
tip extend over the lower lip line, and even when crying tongue didn't
lift.(When crying, babies typically lift and hump the posterior tongue to
protect the airways.) Baby was sleepy, kind of shut down.  Anyway, I pointed
out the tongue-tie to the parents, pumped mom, fed some milk to baby to
jump-start baby's energy so she could wake up, and then showed her some
positioning tricks to get baby's jaw angled better to compensate for the
short, tight tongue.  I ref. to the local ENT who clips, etc.

Follow-up:  Re-Positioning and supplementing a little milk at the BEGINNING
of the feed has accomplished wonders.  Baby is nursing well, gaining fine,
waking up.  Pedi checked tongue, said he was taught not to clip but is
willing to let ENT decide.  Its not a big emerg. now that baby is nursing
ok, but Dad had lots of speech problems as a kid (maybe he had the
tongue-tie, too) and wants it assessed.  But, (and here's the interesting
part which ties in with the herpes)  the Pedi noticed something I didn't:
Baby has a bunch of herpatic sores in the back of the throat.  Mom says she
and older sib. often have these.  I bet money that this is the reason baby
was so reluctant to latch.  After watching my oldest just go through a
horrible summer of mononucleosis (a herpes infection) with 10 days of
horrible pain from lesions on her tonsils, I felt very empathetic with this
baby.  Just goes to show that you can't go jumping to conclusions. Making a
big confrontive deal of the tongue-tie  could have been detrimental to my
relationship with this pediatrician. It turned out that the frenulum was a
red hering.  I think the ENT will clip it as it is pretty tight and all, but
the bfg was facilitated without the frenotomy. Pedi and I both noticed
something the other had not. That teamwork is exactly what ought to be
happening, and I love the back and forth communication.  For this baby,
both problems contributed to baby's initial difficulties, but with good
support and some patience and reassurance, all is now going well.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html