For one of the babies, fast milk flow was part of the problem.  This 
baby had a type 3 tongue tie (the frenulum was placed well back on the 
tongue and behind the gum ridge, but was very tight to the floor of the 
mouth) which reduced her ability to groove the tongue.  I saw her again 
today, a week after her frenotomy, and she did a great job, we got the 
latch just right using the "nipple sandwich" technique (thanks, Diane) 
and it was painless for mom.  I hope she can continue to do a good job 
when it's just her and her Mommy.  Baby has much more tongue grooving, 
and better extension during sucking (she used to pull back her tongue 
and bite).   I did a little gentle work in her mouth to help her "feel" 
where the nipple should go, and showed Dad how to do this.  She does 
have a bit of a sensitive gag, which I find is really common in tongue 
tied infants, but inhibits it nicely if you give pressure to the palate 
and advance the finger very slowly. 

The other baby is not getting enough milk.  We are using a Lact-aid and 
having mom pump, since her weight gain has been slow.  I'm hoping when 
the supply is more generous, this baby will use less pressure.
Thanks all for the suggestions.
Catherine Watson Genna, IBCLC  NYC

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