How did you rule out a tongue tie? Sometimes the lingual frenulum is underneathe a fold of musosa at the floor of the mouth (submucosal), and is invisible but palpable. Normal tongue mobility includes: ability to touch the tongue tip to the palate with the mouth wide open (elevation); ability to maintain the tongue tip over the gum ridge and onto the lower lip with the mouth wide open (extension/protrusion); and ability to lateralize the tongue, or bring the tongue tip to at least the corner of the lips without twisting of the body of the tongue. If any of these three movements are restricted, there is some issue, either from the lingual frenulum or sometimes due to the altered relationship between tongue attachment and mandible in a micrognathic or retrognathic child (short lower jaw or backward placed lower jaw). The restriction of normal tongue movements causes babies to use one of several characteristic compensations, which my group is studying via ultrasound. Another possibility is that the child has altered muscle tone due to a neurological issue. A hypotonic infant might use more of a pistoning movement of the tongue, which can compress the nipple as well. What to do depends on what is wrong, but if mom can bf comfortable with the nipple shield, let her continue doing that. Catherine Watson Genna, IBCLC NYC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET email list is powered by LISTSERV (R). There is only one LISTSERV. To learn more, visit: http://www.lsoft.com/LISTSERV-powered.html