Dear Pat,
     In response to tight or thick labial frenums causing sore nipples and
less of a seal:  I worked with a mom (who happened to be a dental hygienist)
and her 18 day old baby yesterday at our out-pt clinic.
    The baby was still 6 oz from birthweight and she had scheduled for
evaluation of sore nipples.  She did not think weight gain was an issue, since
he was wetting and stooling appropriately.
    He rooted wide and latched well but quickly clamped to crease her on both
sides.  His intake after 15 minutes of nutritive sucking and swallowing showed
a 15cc intake.
    I suspected her milk supply but pumped an additional 35 cc from that side
which we feed back with a starter SNS...the extra flow of milk  seemed to help
him relax his "clamp" and she tucked him in a clutch hold.   She called last
night and reported she was able to pump over 2 oz with an ISIS pump, which she
loves, and said the creasing was minimized with the SNS in place.
    She returns on Friday for a wt check and follow-up.  I do think the labial
frenum is impacting his latch.  The band of tissue covers and clefts the mid-
line of the alveolar ridge to the back of the pre-maxilla (the part we burn
with hot pizza).  This causes those spaces called diastemas when the teeth
erupt.  She is not up for a frenotomy yet, but at least he is still at breast
.

Jan Ellen Brown RDH, IBCLC
Charlotte, NC USA