Dear Wise Women of Lactnet:

PLEASE advise:

Saw a mom today with 6 day old.  Having very painful feeds throughout.  Cracked and bloody nipples.  Baby vomiting the blood.  Mom had pain at the beginning of a feed in the hospital, but not throughout the feed until she got home with the baby.

Baby obviously not opening wide enough, sometimes just on the nipple itself but even with an improved latch mom was complaining about pain throughout the feed, especially a kind of shooting pain down under the base of the nipple.  Mom was really wincing and very uncomfortable, kept having to break suction just to get a break from the pain.  I told her she would probably continue to feel some pain and tenderness for a couple of days, even with a good latch, because the trauma has been done and needs to heal.  She's going to take a break for a couple of days to finger feed her EBM and let her nipples heal and maybe try an occasional feed at the breast.  Mom has no anatomical variations as far as I can tell that would make things this difficult.

Baby hasn't had a weight check but mom reported sufficient poopy diapers and baby clearly suckling and swallowing.  Also, mom reported baby was excessively sleepy the first 4 days and seemed to really wake up on the fourth day.  No sign of thrush.  I assessed for tongue-tie and saw nothing obvious, but had a tough time visualizing baby's tongue extending beyond the gum line while nursing.  

My question is this:  Is there a good way you lactation sages know of to assess a less blatant, yet possibly equally as debilitating, tongue-tie?  Is there a piece that I'm missing?

Julie Rosen, LLLL in New Jersey

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