One evening this week after several days of very sick babies, horrible readmissions and peculiar breasts I told my husband that I really needed to see a healthy newborn-did he know of one.  He answered that, yes indeed a coworker had a new baby and he had encouraged them to call me if they had questions.
The next day, they did call, but unfortunately at 2 days old the little guy was 12% below birthweight, frantic at breast and had never latched more than 1-2 sucks.  He had a very uncoordinated suck, high arched palate and a tongue way back there.  Even with lots of gentle encouragement he did not move it forward to his gum line.  With lots of ABM splashed all over we were able to get him to latch on and get some milk from both breasts.  Mom began pumping.that night.  My instructions were to try to nurse then follow up with bottle(dad) and pump(mom).  This is about my least favorite set of instructions for several reasons, but I really thought getting a lot of milk into the baby was important and that the oral function would improve as the baby got relaxed and full.  I saw them again today-baby has gained some weight, but even bottles take an hour and he is resisting breast feeding again.  Parents are so anxious that I really simplified instructions  to feed, pump rest. 
 I'll see them monday, maybe things will be better and we can switch to a more therapeutic method of supplimentation.  I am concerned that the tongue is really still far back in the mouth.  The parents have never seen the characteristic licking feeding cue.I recommended finger sucking  and immitation of parent with tongue out.  Any hints are appreciated. tracy throckmorton rn ibclc