Simone is exclusively breastfeeding her secondborn child Maggie, who is a newborn. Simone has nipple pain and damage. She consults with Dr Pamela Douglas at Nova Health Co, Wagga Wagga, Australia, October 2023. A big thanks to Simone for her great generosity in agreeing to participate in this video for education purposes including for general use online.

Simone has nipple pain and damage. Her lactation consultant suggested that newborn Maggie needs a frenotomy for tongue-tie. Simone requests a review and my opinion.

Performing an oral and oromotor assessment

1. Preparation for an infant oral and oromotor assessment

A. Photo below shows positioning baby with parent also talking to baby from above, and getting ready to hold both sides of baby's head so that she can't turn it from side to side during examination (but not lifting head from couch).

B. In the photo below, Pam talks a little to baby Maggie, aiming to establish emotional connection and trust, or at least tolerance!

C. In the photo below, Maggie extends her tongue while interacting with Pam, demonstrating that the tip of her tongue extends well beyond lower alveolar ridge. (Successful breastfeeding only requires extension of tongue as far as the lower alveolar ridge.)

2. Demonstration of an infant oral and oromotor examination

A. The video below demonstrates an oral and oromotor assessment, finding a prominent anterior frenulum (at least 70% ventral surface of tongue) and normal white coating on tongue.

B. The video below further displays this newborn's lingual frenulum anatomy.

C. The photo below also displays the lingual frenulum. The frenulum inserts well behind the alveolar ridge.

D. The photo below shows the normal white coat on the baby's tongue and the way the tongue doesn't lift to half-way up the baby's mouth when she is crying a little, which is not relevant. (The pale mottling that appears to be present in this photo on palate is an artifact of this photo - not present in examination, and nor is this the way candidiasis presents.)

E. The photo below shows gentle hands securing baby Maggie's head (not lifting her head from couch though) as Pam checks out the baby's suck. A digital suck assessment actually doesn't tell an examiner very much, since the way a baby sucks on a finger will be highly variable, depending on context in that moment.

Discussing with Simone why frenotomy is not first line of treatment for her nipple pain and damage

The video below shows

• A discussion in which Pam explains why she doesn't believe it necessary to perform a frenotomy today

• A gestalt intervention.

Please see PART 2 of this consultation to observe Pam's next steps in helping Simone.