Hello all,
I saw a mom today (permission to post) whose baby (2 weeks old) had only
gained 3.2 ounces in the past 7 days.  I examined the baby's mouth and he
has a very tight labial frenulum.  I don't think there was a posterior
tongue tie, and the palate was normal.  But the labial frenulum was very
tight and after the mom nursed, she had a significant compressed nipple, in
a line.  She said the most pain was at the top lip.  The baby is now two
weeks old, but in the early days, this had caused significant nipple trauma
and the mom reported cracked bleeding nipples.

Where the trauma had healed on one nipple, there was a significant flap of
skin in an exact line, just the way her nipple was compressed.  It was
almost like a flap of dead skin after a scrape starts to heal underneath.
 It didn't look like it would easily slough away though.  It was firmly
attached and didn't seem like dead skin.  I had never seen anything that
large or significant after a cracked nipple was healing, so wanted to ask.
 I was thinking that maybe the cracked nipple had begun to heal, and new
skin started to grow, but because baby is still not latching correctly,
maybe he is still applying suction in the way that caused the initial
crack, and this caused the new skin to begin to pull away from the nipple
again (?).  Is there anything she should do about the flap of skin?

Also, I don't know what to do about the labial frenulum because I have not
yet found anyone here that does this procedure.  I have tried sending
links, etc, but haven't gotten anywhere yet.  But this is so clearly, to
me, a significant problem for this dyad.  I work in a WIC clinic, so for my
clients it's not always an option to travel to further away providers.

Also, this is the second time in the past couple of months where I saw a
baby with a very tight labial frenulum, causing significant pain and
lagging weight gain.  With the first one, the pain eventually improved, but
the baby continued to have a hard time keeping the upper lip flipped out
and his weight gain was slow.  Mom would flip it out and a few seconds
later it would just suck back in again.  The mom chose not to have the
labial frenulum revised.

I'd appreciate any thoughts.  Thanks!

Sonya Shaver, BS, CHES, IBCLC

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