My guess would be a posterior tongue tie.
 Often these babies can stick their tongues out past their gums when their mouth is only partially open, but when the mouth is open very wide like for latching or crying they are unable to elevate their tongue

This website has a great explanation. 

Www.tonguetieclipit.com

Tania Archbold IBCLC
www.mothersnectar.ca
Ontario Canada



On 2011-09-23, at 13:27, MN <[log in to unmask]> wrote:

> I have seen a mother with a baby who latches on but not effectively (mouth angle 90-100 degree, shallow).
> Mother has no pain but the baby nibbles at the breast without sucking effectively (very negligible intake).
> 
> The mother is probably not managing to stimulate a wide gap and to seems not able to find the movements necessary to help the wide latch.
> She also has rather large nipples.
> 
> I have tried to make an assessment of the sucking ability of the baby, and all seemed well (good grooving, correct wave movement), a part from the fact that the tip of the tongue did not elevate (protruded beyond the lower gum, but did not reach, not even tried to reach, the upper gum when stimulated nor when the baby was crying).
> 
> The one time we did manage to have the baby latched properly, she breastfed beautifully for a couple of minutes with a good swallowing rhythm and measured milk intake.
> Then she got off the breast and that was the end.
> 
> There are, in this case, many factors that may be contributing to the poor latching, but I am wondering if the fact that the tongue did not elevate has a clinical meaning, or if it could be irrelevant.
> 
> I have not managed to find out if the baby occasionally do elevate the tongue tip or not. I have asked that to the mother, explaining that if the baby does not do that, it could be sign of a problem (which could explain their difficulty), but the mother never answered directly.
> 
> Hope you can share your experience on tongue tip not elevating.
> Could it contribute to poor mouth opening?
> I am convinced enough that the problem is in latching, rather than in suckling.
> 
> Thank you for any suggestion.
> 
> Micaela
> LLL Leader, Italy
> 
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