Julie, you wrote the following in regard to your sister,

Latching on, everything looks wonderful (mouth is open wide, =
lips are flanged, you can hear & see swallowing), but she says it feels =
like his tongue is scraping her breast.  When she takes him off the =
breast, her nipples are shaped like a tube of lipstick, so there is =
obviously a problem with the way he is sucking. 

The everything looks wonderful latch often does mean difficulties with tongue 
movement or mobility.  Since the baby's weight gain is good and even above 
average, could he be defending against rapid flow or copius amounts of milk and 
using his tongue defensively?  Uphill nursing with baby's head higher than 
breast (nose at about 12 o'clock, chin about 6 o'clock) with mom semi reclined or 
side lying positioning could help, or baby prone on top of mom also helps 
tongue extrusion.  The other possible problem is tongue tie with a high palate.  
Check for length of frenulum, placement either anterior or posterior in 
attachment to tongue and also where the frenulum is attached to floor of mouth, 
shape of tongue on extrusion (presence of cleft at tip, even mild one) and how 
tongue extrudes, pointing down or curled under indicates tongue restriction, and 
whether tongue's anterior half elevates symmetrically with crying.  

I saw a baby the other day who transferred zero milk at breast, clicked 
constantly during feed with supplement at breast and mom reported same clicking 
with bottle, had a long frenulum attached normally to tongue but "went in the 
wrong direction" with attachment to lower alveolar ridge.  Tongue had slight 
cleft, pointed down with extrusion, and did not fully elevate with crying.  
Hopefully the ENT to whom pedi sent mom and baby will clip, otherwise mom will 
hopefully be willling to travel some for clipping.

Barbara Latterner, BSN, RN, IBCLC

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