When I see a baby stick her tongue out and keep it out past her gum 
line, I always inwardly cheer. But we have to look at the whole picture 
and remember that a baby who has oral motor issues is going to 
compensate somehow. So, we can't just say, the tongue looks fine if the 
milk transfer is poor or mom has sore nipples. Something is wrong when 
the latch on is not working correctly or baby can not transfer milk 
correctly. Just by looking, the baby may appear fine and the sucking may 
"look" great. But if there is not good milk transfer with an abundant 
milk supply, something is wrong. With situations that are not obvious, 
repeated test weights have shown me when the baby is not improving and 
therefore what the problem might be. I also will observe how the baby 
bottle feeds on a wide based bottle to see how the lips and tongue work 
if observing the breastfeeding is not enough. Sometimes baby can 
transfer well for say 10 minutes at the breast and then it all goes down 
hill and there is poor transfer (but mom can pump a lot more out after 
nursing). This is when I refer to someone else, usually a good SLP to 
assess the baby. And I have had moms argue with me about how they do not 
think baby is tongue tied, when I do, and the weight gain is very very 
bad. Once they get the tongue clipped (if they do), the moms all say how 
much better the latch on is. I show them via test weights how the intake 
is not as it should be and sometimes this takes 2-3 sessions with her. 
But clipping is not always the cure, some babies have other oral motor 
issues. And mom has to decide what she wants to do as this is her baby. 
Her enjoyment of, and relationship with, her baby is very important to 
the baby's emotional health.

Kathy Eng, BSW, IBCLC

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