I can think of two possibilities. One is that the lower jaw is too small
for the tongue to fit there, so the baby habitually keeps it on the roof
of the mouth. If the tongue is just resting there, that would be my
first guess. I sometimes have success with fingerfeeding these little
"peanut butter tongue" (thanks Pat Gima for this evocative description)
kids for a feeding or a day, to help them learn that food goes above the
tongue!
The other possibility is that the baby has a respiratory instability and
is fixing the tongue to the roof of the mouth to maintain airway
patency. If this is the case, there will be significant muscle
activation in the underside of the tongue (you will be able to see the
difference, in a baby who rests the tongue up, the tongue is relaxed and
smooth, in the baby who fixes it, the tongue looks like it's composed of
concentric semicircles or ovals at different levels. The trying not to
be on the back can be a sign of airway issues, laryngomalacia or
tracheomalacia are more severe if the baby is supine or if the head is
not extended. Perhaps the baby is trying to extend her head, and if she
is still very small, this movement may be enough to flip her onto her
side. (Fetuses use a whipping around of their head to turn their body in
utero, that's why some newborns are able to turn onto their side, they
are using their neck muscles, and their body is light enough to go
along. When they deliberately roll at 3-5 mos or so, they are using
muscles in their trunk, hips and limbs as well.) If there is an airway
anomaly or instability, the baby will usually have some stridor (high
pitched squeaky breathing during feeding, crying, or when stressed),
will suck in very short bursts (3-5 sucks and then a long breathing
pause) and may refuse to eat. Breastfeeding works best when these babies
have their head well extended, mom is reclining so they are prone or
semi-prone, and they are allowed to pace the feeding themselves (they
often do well with short, frequent feedings).
Catherine Watson Genna, IBCLC NYC
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