In response to the advice to massage the mandible. Be very gentle with the
massage. Deep or firm massage causes the muscles to fire increasing tone. You
are trying to decrease tone so use very little pressure, if any.  A gentle
brushing is more in order here. As for pressing down on the chin, although it
may help to bring the tongue down and forward over the lower gumline in a
hypotonic baby, it may serve to do the opposite in a normal or high-tone
baby. Firm pressure will encourage the muscle to contract. The mentalis
muscle is one of the muscles that will respond to this chin pressure and when
mentalis tenses so will orbicularis oris (the sphincter fibers around the
mouth)  which will cause the tongue to retract behind the lower gumline.

It is my opinion that unless a particular LC has mentored training in the use
of these therapeutic techniques, she should leave this kind of work up to the
PT, OT,  NDT or speech therapist. We can do more harm than good if we start
messing around without understanding the full implications of what we're
doing.

I have seen my share of babies with aversive behaviors at or to the breast
because they were "messed with".

Please be careful.

Alison Hazelbaker, Off to learn the Neonatal Oral-motor Assessment Scale and
PT approaches from Marjorie Meyer-Palmer in early November. Want to come?