Joseph took his trip to the Big City (Seattle) yesterday where we spent 1.5 
hours w/ a pediatric OT/PT at Children's Hospital Regional Medical Center 
for his feeding evaluation.

The results showed two significant things:

1) Joseph has underdeveloped ("hypotonic") cheek muscles which prevent him 
from creating the negative suction required to transfer milk from me to him 
when breastfeeding.  This has also meant he cannot maintain a good seal on 
breast or bottle, hence leaking, spilling, spitting of milk.  The cheek 
muscles have gotten this way from lack of/improper use.

2) Joseph has a tongue that bunches up in the middle which causes a reverse 
tongue thrust, thereby compressing the (breast or bottle) nipple between the 
bunched up tongue and the hard palate.   This is part of the reason he has 
had such a shallow latch and obviously why he pushes the nipple out instead 
of pulling it inward.

We have some exercises to do with and in between feeds for the next two 
weeks.  We hope to get those cheek muscles stronger so he can eventually 
transfer milk successfully and help him learn to suckle properly instead of 
tongue thrusting.

(The therapist also thinks Joseph may have silent reflux, so she made him a 
wedge for nighttime sleeping)

Ann Marie
(RN, IBCLC, MOM!) 

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