Had worked with baby at hospital, has sl.receding chin and tongue possibly a little short, no tongue tie.  Mom's R. breast and nipple okay, tissue pliable,no inversion.  L.breast had partial mastectomy for a cancer. Very little nursing accomplished at hosp.  Retracted tongue, but with some suck practice and squirting milk in mouth and on breast, able to get him latched myself only two times in two days, suggested possible future need for a breast pump.  Called me a full day after discharge & was engorged and unable to latch.  
WMP, pumped and after suck practice again able to get latched in side-lying position with much assist. Nursed well at least 1/2 hour.  Encour.to finger feed supplement or pumped milk(no less than 8 x's/day) if unable to latch.  Over next few days, mostly poor latch, with 1-2 times successful.  Not supplementing as much as encour.  Seen again approx. week later, suck practice not helping tongue retraction and not latching, had been supplementing some.  Baby sleepy, hard to keep awake.  Attempted latch, unable.  Nipple shield-latched and nursed well, with lots of swallows.  Encour. to supplement if unable to latch or if poor nursing session, no less that 8x's (but urged 10 x's) in 24 hrs.  Given a range of 1-2 oz.per feed, depending on how he nursed.  Birthwt.7# 9oz.,disch.wt.7# 2oz.,now 6# 14oz.  Kept in contact every couple days, reported nursing well with shield (30-45 min. each feed,sometimes 90 min.),lots of swallows,required some stimulation some feeds.  Also, reported lots of wet diapers and lots of yellow poops. Active baby at feedings.Friday wt.on 3/5 was back up to 7# 2oz at clinic.  Mon.3/8, wt. 6# 14, but clinic thought scale problem, so we weighed him at the hosp.(6# 12.8).  Ped. asked me to keep working with them.  Recomm. supplement to equal range of 125 Kcal.- 150 Kcal.per Kg. for no less than 8 feeds, to cont. suck practice prior to latch with shield, to let nurse for 15 min. while swallows the strongest and then supplement.  Wt. today(hosp.scale) 6# 15.2, so up 2.4.
My dilemma.  He is not retracting tongue anymore, but tips up the end when trying to get wide open mouth for latch.  Mom a wreck, asking when do you know it's time to give up or that it might not work.  Willing to just pump.  Dad not completely supportive (unplanned baby), has always questioned just feeding him formula and not withholding food for breast.  Now stated..."I don't want my kid being developmentally delayed from inadequate nutrition..." and "How does breast milk compare in nutrtion  to formula...."  From my limited experience in practice and from reading, I suggested that this is something he should outgrow (the receded chin and tongue) and can learn (suck practice to help him keep tongue down.  The veiled threats on Dad's part ( a lawyer) have unnerved MY confidence in whether I am correct in assessing the problem and  in suggesting  a plan of approach.  Mom is feeling better about all today,with the gain.  Reports that he seems to be darting or wiggling his tongue around now when at breast with the shield.  I stressed that when he is finger fed, that she remain very conscious and diligent with the suck practice at the same time and that I still think he'll outgrow and learn.  What am I missing, or is it reasonable to assume he'll outgrow?  I wish I had at least 10 extra years of practice and I am all she has  for help.  Sorry so long,  thanks for your ideas...Faylene Nelson, RNC, IBCLC, in Helena, MT.  weather like spring here.