Pat Gima, IBCLC one of our LactNet fellows, calls this "peanut butter 
tongue" when the baby keeps the tongue up and can't latch.

Peanut butter tongue is more likely when the baby was not given the 
opportunity to be skin to skin and breastfeed right after birth (I 
believe this was one of Righard and Alade's studies, the one about 
sucking skills and skin to skin). It can also happen when the baby has a 
respiratory problem and is using the tongue to stabilize the airway. You 
might hear noisy breathing or see the baby tip his head back and breathe 
with his mouth open if this is the case. Babies with short lower jaws 
(mandibles) can also have this problem. What you do to help depends on 
the reason the baby is lifting the tongue.

If it's just habit, having mom or dad tickle the tongue tip down with a 
clean finger right before latching may help. Having mom express a few 
drops of milk on the nipple and letting the baby lick them off gets the 
tongue in a better position too.

If it's respiratory, having mom lean way back (which seems to help all 
babies according to Susanne Colson's research, she calls this Biological 
Nurturing positioning) so baby lays on his belly more will allow him to 
put his head back and nurse uphill, both of which help.

If these don't work, sometimes fingerfeeding once or twice teaches the 
baby that food goes on top of the tongue.

Catherine Watson Genna, BS, IBCLC   NYC

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