Camille -- on the few occasions I have met a baby who has a normal oral
structure but whose tongue never passes the lower gum ridge, breastfeeding
has not been successful.  These babies can usually make a tight seal with the
tongue on your finger (a good sign -- failure to do this could indicate
dysfunctional suck) but aren't able to cup and seal on the breast.  I like to
observe a bottle-feed with these babies to see if they have a coordinated
suck/swallow or push milk out of mouth with each attempt.

A baby who will occasionally flick her tongue over the labial border can
usually be trained to bring the tongue forward to breastfeed.  Those babies
I've seen who chomp on my finger and never protrude tongue have ended up on
expressed milk.  I am concerned about these babies -- I feel they have missed
a very basic milestone.  Am following one now to see if any other
difficulties develop.  OTs and Speech Pathologists I have spoken with seem
consistent in their observation that inability to breastfeed is an indicator
of future feeding and speech difficulties.

I would love to be able to have these babies evaluated by an OT but this is
not ok with insurance -- you have to wait until failure-to-thrive kicks in.
 If it does this will likely be at around 8 months.

There seems to be a gap in options when we work with babies with persistently
disorganized or mildly dysfunctional sucks.

Joanna Koch, IBCLC