Hello Wise Ones, I am in need of advice (all speculations welcome).  I am currently working with a mom on a weekly basis of an 8 week old infant.  The baby had a very tight frenulum at birth and it was clipped at 3 weeks (though not quite enough, imo).  The clipping improved the baby's suck, but tongue extension was still lacking.  When the mom came to see me at 3 weeks postpartum, the baby had been diagnosed as FTT.  Baby's birth weight was #6.8, lowest weight #5.5, and at 3 weeks was #6.1.  Baby would not breastfed in the beginning, even with SNS at the breast.  Got mom pumping and feeding ebm by cup and finger feeding.  Weight slowly improved, but baby still not latching at the breast.  I had mom start using a newborn nipple shield at 5 weeks, and of course the baby was able to latch onto the shield.  Mom was still pumping at this point and alternating sns at shield and finger feeding baby.  At 6.5 weeks, we finally weaned the baby off of the shield.  Baby initially nursed poorly, and mom complained of severe nipple pain.  I felt that the pain was mostly due to the fact that the baby's tongue still was not extending past his gumline and he was "chomping" at the breast.  Mom has really hung in there, baby has not received any abm since 3 weeks old and the weight yesterday was #9.2.  Mom still complaining of very sore nipples, but is now describing the pain as "burning".  When I examined the baby's mouth, I found an unusual looking "ulcer-type" sore in the middle of his palate.  It is aprox. 1 cm. across by 1.5 cm. in length.  It had white edges all the way around, and was slightly reddened in the center.  No typical signs of thrush.  I explained to the mom that I still suspected thrush, but that she needed to get her ped. to look at the baby's mouth.  Mom took baby to the ped. today, he said that he felt that the ulceration was caused by the SNS.  I feel quite sure that this is incorrect since it has been over 1.5 weeks since anything has been put in the baby's mouth, besides mom's breast.  I see this mom once a week, and always examine the baby's mouth--it was not there 5 days ago.  The doctor encouraged the mom to purchase the Avent bottle system and proceeded to tell her how much he dislikes the SNS.  I am not sure why he would recommend the bottle to her as she is now exclusively breastfeeding.  He did prescribe nystatin for her and the baby.  My questions are first, has anyone ever seen a SNS damage a baby's palate?  I would think it would be more likely that a fingernail could do this, but again this ulcer was not there a few days ago.  Secondly, can thrush cause a lesion such as described??  I know a bottle is the last thing that this baby needs at this point--he has just learned to breastfeed!!  Mom is very committed and has great trust in me.  I would feel awful if I had unintentionally harmed this little fellow.  I am also curious to know if the way that the baby nurses could have caused this.  Any ideas would be most appreciated.
                                  TIA,
                           
                                   Pam Holland, BS, IBCLC
                                        Savannah, GA
             "Be careful not to stress so much to get your kids what you didn't have, 
                           that you forget to give them what you did"