From Cathy G, posted by me as she has been busy on Lactnet today and exceeded the tree post limit :-) Her post follows below. Rachel (beneficent listmother) Alison has revised the HATLFF in an effort to capture more posterior tt's. I personally put the most weight on the baby's ability to elevate the tongue during crying, lateralize the tongue when the transverse tongue reflex is stimulated (which also helps you assess for torticollis, in which case lateralization will be restricted to only one side), and keep the tongue tip over the lower gum consistently while sucking my finger and the breast. I also look for abnormal sucking compensations in the digital suck exam.I wear well fitted vinyl gloves, when your gloves are tight that really helps. Feeling the peristalsis comes with practice, and you need to use fluid to feel it. Babies suck differently before and after the milk ejection reflex, so when there is suspicion of a tt or sucking problem it's important to do both a dry and wet assessment with some expressed milk (good time to teach mom manual expression of milk so you can use the milk for the assessment). How many normal babies are you seeing? It can be a problem to form a good mental map of normal if we only see problematic babies. I find my experience as a LLL Leader invaluable there, you probably do too. Catherine Watson Genna BS, IBCLC NYC cwgenna.com-- *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome