Does anyone have words of wisdom for me about this case? I have permission to share:

Mom and baby seen at 3 weeks, problems are "nursing all day" and sore nipples. Baby wants to nurse constantly for 8-11 hours per day.  He is also very fussy at breast, breaking off and on, gulping and becoming uncomfortable with letdowns.He does OK at night, though, sleeping for a few hours after each nursing. Reclining position did not help. Can only seem to handle flow at night when half asleep. Lying down nursing during day does not help- still fussy. 
On exam baby has a tongue tie- moderate. A clipping is done. 
After clipping he can move his tongue better but still is uncomfortable for long periods while nursing most days- really seems to be unable to handle flow. I don't see any obvious breathing difficulties that might make him sensitive to normal flow. Mom's supply and letdown don't seem excessive- though maybe they are as he's gained almost 2  lbs since birth (now we are almost at 1 mo of age). But if it's OMER and/or oversupply,  why doesn't positioning help?
Left nipple is quite sore- had a plugged duct with milk blisters last week. She has short nipples, breasts are soft. Baby gets a good latch, then moves back so nipple  is not far enough in. Seems to be clenching a little too, and his jaw excursions seem a little excessive. When he comes off nipple is lipstick shaped and red and she has pain while end of nipple turns white. Using warmth for this.
Right nipple is not sore- but right breast has implant (never developed) and low supply and flow so she doesn't nurse on it as often.  
She is doing tongue exercises from K. Genna's book- massage on end in circular motion, let baby suck on finger, press down and out. 

OK- so now it's been 4 days since clipping and Mom is very frustrated. The plugged ducts seem resolved- pain is now from nipple not being far back enough in mouth and vasospasm, I think. She has to take vicodin at times for the nipple pain. She is going to check in with supportive Ped on Monday, and talk to the ENT who did the clipping. But then I think she's going to quit unless something changes drastically. 

I'm stumped. Before I saw them I guessed overactive letdown. Then thought the clipping would help. Now I wonder if baby should be re-clipped or what?? 

Mary Taylor, IBCLC

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