If the posterior tongue is humping strongly, it's likely that there is a 
posterior tongue tie. They can be treated just as easily as the obvious 
ones, with a little snip. There is a little more bleeding, and the 
mucosa opens up into a surprisingly large diamond shape, and heals 
without suturing. It shows how much restriction was really there. One 
can get some clues to posterior tongue ties from watching the tongue, 
and the most common sucking pattern is retraction humping and biting, 
since the gums become exposed and trigger the bite reflex.

Another possibility from what you describe is the uncoordinated 
pistoning movement that some kids with neurological issues use. I've 
seen some children with genetic disorders (including Prader Willi and 
Phelan McDermid syndromes) that used that sort of motion. An 
occupational therapist may be able to help, or you could try some of the 
standard "suck exercises" used by lactation consultants. You'd want to 
see first if the baby accepts oral touch, if so, then you can use some 
stroking along the midline of the tongue to encourage 
extension/protrusion; and perhaps "walking back on the tongue" to 
encourage peristalsis. Central grooving is very important to maintaining 
the breast in the mouth and for bolus control no matter how the baby 
feeds. A tug of war game with a long cyllindrical pacifier might help 
improve central grooving and tongue strength. The Breastfeeding Answer 
Book has some good ideas, as do PreFeeding Skills 2nd edition by Morris 
and Klein (available from Therapy Skill Builders, www.psychcorp.com) and 
the classic Feeding and Swallowing Disorders in Infancy by Wolf and 
Glass (ditto on the publisher).

Well, that's my three for today and it's not even 7 am, so I quess I can 
get back to work!
Catherine Watson Genna, IBCLC  NYC

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