I hate to be a broken record, but look underneathe the tongue, and slide 
a gloved finger underneathe and look at the tongue attachment.
Clicking isn't really such a problem if the baby is getting sufficient 
milk and is able to coordinate swallowing and breathing well, and mom is 
comfortable. We think it is caused by the frenulum and floor of the 
mouth pulling the tongue back down rapidly when it elevates at the limit 
of elasticity. It's not a problem in and of itself, it's just indicative 
of the fact that the baby is fighting the tongue attachment during 
sucking. If it still "works" and the palate is pretty normal, we can let 
the baby be. A really good asymmetrical latch challenges the baby's 
ability to elevate the tongue LESS, because the breast gets fatter as it 
goes back, so baby's tongue does not have to lift as far to compress the 
breast. That's why latch is always our first intervention.

You didn't mention what the baby's weight trajectory is, or what the pre 
and post feed weights were... that would help a lot in determining 
whether baby's sucking was "working" or not. Another thing to look for 
on the minus side is tremor of the lower jaw and tongue. This indicates 
fatigue from excessive work of sucking, and means the baby should get 
more scrutiny.

Occupational therapists think tongue thrust is an indication of low tone 
in the tongue. The baby can't organize the muscles that comprise the 
tongue to shape and move it properly, so the movement that comes out is 
a strong outward movement, that is definately stronger than the inward 
movement. Is that the movement you noticed? Sometimes a sliding motion 
of the tongue feels the same way, but is the same amplitude and speed on 
the inward and outward component, unlike thrusting. Sliding happens when 
the tongue is extremely tight to the floor of the mouth, and the baby 
uses that movement rather than peristalsis.(Mom may report that baby's 
sucking feels like sandpaper on her nipple).  It goes along with an 
inability to groove well, which goes along with poor bolus control. Have 
you noted any of this with this baby?  There are exercises one can do to 
improve tongue grooving, see if you can find them in the archives, I'm 
sure I posted them, perhaps from my old dorsai.org address. Let me know 
if you can't find them.

Catherine Watson Genna, IBCLC  NYC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html