From Cathy G, posted by me as she has been busy on Lactnet today and
exceeded the tree post limit :-) Her post follows below.  Rachel
(beneficent listmother)
Alison has revised the HATLFF in an effort to capture more posterior tt's.
I personally put the most weight on the baby's ability to elevate the
tongue during crying, lateralize the tongue when the transverse tongue
reflex is stimulated (which also helps you assess for torticollis, in which
case lateralization will be restricted to only one side), and keep the
tongue tip over the lower gum consistently while sucking my finger and the
breast. I also look for abnormal sucking compensations in the digital suck
exam.I wear well fitted vinyl gloves, when your gloves are tight that
really helps. Feeling the peristalsis comes with practice, and you need to
use fluid to feel it. Babies suck differently before and after the milk
ejection reflex, so when there is suspicion of a tt or sucking problem it's
important to do both a dry and wet assessment with some expressed milk
(good time to teach mom manual expression of milk so you can use the milk
for the assessment). How many normal babies are you seeing? It can be a
problem to form a good mental map of normal if we only see problematic
babies. I find my experience as a LLL Leader invaluable there, you probably
do too.
Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com--

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