Hi Lisa.

I have worked with babies with low lip tone that struggle with lip flange separate from tt/lip tie issues.  In this case, baby will benefit from some oral motor strengthening.  The best info I'm familiar with for this is Beckman Oral Motor training.  I wonder if any SLPs or OTs in your area are trained in this?  They have a website listing people who have taken this training.  However, it's not a complete listing, and all attendees haven't excelled in the training or are familiar enough with it to be effective, so ask questions first.    

You also wrote that ,"When mom bottlefed EBM, if she got one lip to flange, the other would tuck back in.  The top lip was very red while he fed.  He also leaked milk out of the corners of the mouth."  My first thought is what bottle?  She needs to choose a nipple with a narrow base that doesn't cause the top lip to overly stretch.  Stretching to the point of reddening or blanching usually means the nipple is too wide.  The milk could be leaking from the corners because the bottle nipple, again, is too wide for the lips to form a complete seal.  I'd start with changing the nipple.  A narrow neck nipple will also allow the mom to apply light pressure to the lower lip to keep it flanged.  

Warmly,
Amy Peterson

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