Hi Merilee,
Glad to see you back on lactnet!
Sometimes using a mini haberman for a few days and then switching to the
regular haberman teat can be helpful with these little hyperactive gag
babies.  I also suspect that the hyperactive gag is the result of the
tongue being restricted so that it never touches posterior to the very
front of the palate.  The restriction makes the clicking.  Usually these
kids have 2 problems, the midtongue restriction and the hyperactive gag,
and sometimes the anterior palate is very high from the little tongue
tip resting there.

Chele Marmet uses fingerfeeding with gradual increase of finger depth
over time with this scenario.
An OT trick is to press strongly on the anterior palate until the baby
relaxes, and then slip the finger back slowly.  Also pacifier tug of war
with a gel filled cyllindrical pacifier like the Playtex gel filled
Binky can be helpful in helping the baby normalize perception.

And for the tongue restriction, asymmetrical latch and some sublingual
support can be helpful.  These kids generally "get it", but it can take
a few months for them to be totally on the breast and not just gumming
mom's nipple base.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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