My third child was having problems everting her top lip from her first feed
after birth. I attempted to manually pull the lip out but it kept rolling
back under. I was quite disappointed as at the time I had just passed the
IBCLC exam and liked to think of myself as somewhat of an expert. It wasn't
until I read an article in the Journal of human Lactation that week about a
tight upper lip frenulum causing inversion of the lip that I did a really
good look at my daughters frenulae. She had a very large and tight frenulum
which crossed onto the gum and held the lip flat against the gum. It was
impossible to rub my finger along the top gum as the frenulum was in the
way.
This was the cause of her feeding difficulties. Perhaps this baby you are
seeing has a tight lower lip frenulum. I actually took my daughter to an
oral surgeon in Adelaide and he felt that the frenulum needed surgery at
some stage before  she turned twelve. As it required a general anaesthetic
he said he would only do it if it was interfering too much with the
breastfeeding. By this stage I had managed to get her on and feed with very
little trauma and I decided against the op.
The oral surgeons comments were 180 degrees from the Paediatricians who had
said " tight frenulae cause no problems".
The oral surgeon felt that if left long term these things can pull gingival
tissue away from the teeth and cause gum deterioration and chronic
gingivitis- hence the need to perform the op pre teen [as she could
tolerate a local at that age]
It would be worth very carefully checking the lower lip on this child.
KIM SHORT
general practitioner/LC
BRISBANE,aUSTRALIA
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