Lyla,
This baby's tongue is definitely restricted from what you describe.  The
clicking, asymmetrical tongue elevation, and difficulty holding a milk
bolus for a controlled swallow are tip offs.  Babies with poor tongue
mobility usually use one or both of two compensations in their sucking:
  excessive jaw compression (biting the milk out) and excessive lip
movement (using the lips to move milk from the breast).  It sounds like
the baby you saw is combining these two strategies.  If the baby's lips
are habitually curled in, it is possible that the labial frenula are
tight as well, but the baby might also be doing this "fixing"
deliberately to get more "oomph" in his lip movements.

The high anterior palate and the hyperactive gag reflex are typical of a
baby with restricted tongue elevation.  The tongue can't get up there to
spread the palate, and the palate is naive to stimulation and
hypersensitive.  Babies with tight tongues may resist opening their
mouths wide to avoid painful traction on the frenulum or tongue attachment.

The other possibility is that there is a mild neurological problem, with
low tone and asymmetrical tongue movements.  Hypotonic infants often use
fixing and compensatory sucking strategies.  Sometimes both conditions
exist in the same infant, and the relative contribution of each thing
can be difficult to unravel.

I would certainly refer this baby to an ENT.  Sometimes, if there is no
lingual frenulum but the tongue attachment is restrictive, a procedure
called frenuloplasty can be performed.  Unfortunately, it requires
general anesthesia and stitches, but several babies in my practice have
had this procedure with great results.  It can be difficult to find an
ENT who will do this surgery.  It can be helpful if you fax the doctor a
report outlining your observations of the baby's feeding and tongue
funtion before the baby's appointment.

An asymmetrical latch will also help the baby in several ways.  By
placing the nipple just out of reach on the baby's philtrum (the little
ridge between the baby's upper lip and nose), the baby is required to
both open wide to reach the nipple, and extend his or her head.  When
the baby opens, mom pulls baby straight to her by his shoulders, further
extending the head and winding up with his lower lip and tongue tip
further from the base of the nipple than the upper lip.  Because this
gets baby's mouth on a "fatter" bit of breast, the tongue needs to lift
less, so the restriction is less of a problem.  Using a modified
football/clutch hold so the baby's body is upright is also helpful, then
mom can lean way back and that will help milk flow to the front of the
mouth.

In this particular case, I would also advise mom to bf on one breast at
a feeding, or even one breast two feedings in a row, to increase baby's
fat intake and reduce the gassiness of lactose overload.  If feeding is
stressful and scary for baby due to inability to control milk flow, he
is likely to refuse to breastfeed at all once sucking becomes more
voluntary at around 3 mos of age.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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