I am asking for your help and experience on a case for which I have nothing
else to suggest to the mother.

Baby is 3 weeks old now. This is her second child. Her first was breastfed
to 9-10 months. She called me for the fist time for very sore nipples on day
3 (the baby was also making clicking sound at the breast).  At the visit her
two breasts were very engorged, red and swollen. We tried (for about an
hour) with little success to relieve the engorgement enough to get the baby
to latch on correctly. But the baby did not latch on ok and the pain was so
bad that we couldn't work on latch on technique. So the mother stop nursing
at the breast and finger fed the baby with her express milk (which she has
plenty) for 24 or 48 hrs and let the nipples heal enough so we would be able
to work on the latch. I evaluated the baby's suck while teaching the mother
and grand-mother to finger feed. The baby was doing something weird with is
tongue: it was moving in and out, and when it was out: the end of the tongue
was pass the lower lip. It seemed like if the tongue was too long and when
it was all in the mouth it was too tick. The 24-48 hrs turned out to be
almost 3 days I saw her on day 6 for the second time. Most of the
engorgement was relieved on the left breast, but the right breast was still
full and red (not as bad as day 3).  The baby presented is tongue at the
roof of the palate. But the mother is very quick and puts the baby to breast
in the fraction of second he gets his tongue down. The baby latch on
perfectly with no pain (or it's what it seems to the mother compare to the
excruciating pain she felt before). The baby's suck relieved the mother of
the engorgement she had on the right beast (babies are so much better than
pump!) . I thought everything would be ok from this point.

She call me two weeks later for nipple pain again. The baby is gaining well.
She and the baby have no symptom of yeast infection. She doesn't have any
visible sore and, after the feed, her nipple have a white stripe in spite of
a very big mouthful or breast. I check is sucking pattern again to see if it
was still weird. And it was the same. If I extended my finger just a bit (a
millimetre) it was touching the soft palate at the end of the mouth. It
seems like is mouth is too short so, when is tongue is in his mouth, the
tongue gets ticker and leave little room for the nipple who his probably
compress at the end of the mouth.

We tried a lots of different positions to get the tongue to go down as much
as possible: modified football hold (baby sitting), mother lying on her
back. The mother tried sucking training for two days (baby face down sucking
finger when the mother is waking) I don't know what else to do. I would like
to tell her something else that it's going to get better as your baby (and
his mouth) will grow. Please help me to help her.

Marie-Josee "a not as experimented LC as she would like"

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