How did you rule out a tongue tie? Sometimes the lingual frenulum is 
underneathe a fold of musosa at the floor of the mouth (submucosal), and 
is invisible but palpable. Normal tongue mobility includes: ability to 
touch the tongue tip to the palate with the mouth wide open (elevation); 
ability to maintain the tongue tip over the gum ridge and onto the lower 
lip with the mouth wide open (extension/protrusion); and ability to 
lateralize the tongue, or bring the tongue tip to at least the corner of 
the lips without twisting of the body of the tongue. If any of these 
three movements are restricted, there is some issue, either from the 
lingual frenulum or sometimes due to the altered relationship between 
tongue attachment and mandible in a micrognathic or retrognathic child 
(short lower jaw or backward placed lower jaw). The restriction of 
normal tongue movements causes babies to use one of several 
characteristic compensations, which my group is studying via ultrasound.

Another possibility is that the child has altered muscle tone due to a 
neurological issue. A hypotonic infant might use more of a pistoning 
movement of the tongue, which can compress the nipple as well.

What to do depends on what is wrong, but if mom can bf comfortable with 
the nipple shield, let her continue doing that.
Catherine Watson Genna, IBCLC  NYC

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