Hi Andrea,
A few things about your description of this baby raise red flags for me.

You mention that there is a notch on the tongue tip that is slightly off
center.  This could mean that there is an asymmetry in either the tongue
structure or tone.
You also mention that the suck was strong but not rhythmic, and that
cupping was weak.  Babies often use excessive compression to compensate
for tone problems or tongue-tie.  The loose cup would also occur in
either situation.

I'd recommend you take another look, and try the digital suck exam with
some milk (with either an eye dropper placed at baby's lips along your
finger, a periodontal syringe, or a tube feeding device on the finger)
to get the true picture of what is going on here.

If there is a tone problem, some oral stimulation, especially vibratory
stimulation to the tongue (one classic exercise is called "walking back
on the tongue") should prove helpful.  Don't neglect positioning issues
such as giving baby excellent support and hip flexion.  A modified
(sitting) football hold works well.

If the frenulum is restrictive (if it inhibits tongue elevation,
simultaneous elevation and extension, cupping, or transverse tongue
motions), strongly consider referral for an evaluation to see if
frenotomy would be helpful.  In the meantime, an asymmetrical latch with
lots of tongue contact with the breast and head extension to increase
jaw and tongue contact should be helpful.  Tongue-tied babies can
require long feedings very frequently.  With my own tongue-tied,
hypotonic son, I did almost nothing but breastfeed for the first 7
weeks!
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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