The thing that makes assessments so difficult is that there can be opposite
reasons which cause the same thing.  The bunching of the tongue in the rear
of the mouth can be caused both by high and low tone.  If the baby is
hypertonic, the tongue may be PULLED into the back of the mouth by too much
muscle tension and the tendency of the baby to arch back.  If the baby is
hypotonic, the tongue may FALL back. Wolf and Glass say that  other small,
weak, low tone infants seek postural stabilty through tongue retraction. I
think that means they are tensing up the tongue trying to maintain head
control.   Increasing their postural support - esp at the shoulder girdle -
helps them a lot.

 Even though this all seems contradictory, the big thing to know is that it
is critical to find some way to help the baby, because if the tongue is not
in the normal (extended and grooved) position, the baby can't control the
bolus of milk, can't create sufficient negative pressure, and the position
of the tongue may obstruct the phyaryngeal airway.

The other big thing to know is that tone problems and feeding dysfunction in
general are neurological soft signs.  Typically babies will improve over
time and out-grow or mature past these problems.  Esp. if they are caused by
birth trauma or meds.

Asymmetries of the jaw, where the lower jaw is very recessed (over-bite)
create problems with locating the tongue where it should be.  It really
helps to bring the baby to breast in a position which prioritizes placing
the lower jaw on the breast first.  Bringing the chin in closer to the
breast will  bring the tongue forward, altho you want to avoid extreme
hyperextension of the head.  Since the baby under discussion arches,
bringing the head and neck into better alignment is an important starting
point. Hip flexion will also assist in this.   The arching suggests that
hypertonicity (rather than low tone) may be the problem.  PTs, OTs and
Speech pathologists use gentle vibrating techniques to the tongues of babies
with retraction due to hypertonia.  They also recommend use of long nipples,
which provide greater contact on the tongue and promote more effective
tongue movements.  I think I recall that there was a suggestion to throw
away this infant's pacifier.  Maybe the infant could profit from some
judicious use of it -- esp. right before a feed to help increase the
proprioreceptivity of the tongue.

By the way, the Playtex nipple only appears to be short.  If you suck on it,
it extends to a much longer length than the Avent.  I measured it with a
ruler.  I think it's too long, and like the length of the Avent better.
Barbara



Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html