The recessed jaw/short tongue combination is probably the most difficult
anatomical variation for feeding.  WHen the mandible is pushed back, the
tongue attachment winds up closer to the gum ridge than it should be,
restricted the ability of the mid-tongue (talking in an
anterior-posterior direction) to elevate toward the palate.  Add in a
high palate that has not been spread by the unusually short "free
tongue", and we have real trouble.  Often moms need support for
breastfeeding when they can get a good asymmetrical latch with head
extension to bring the short jaw in toward the breast; and pumping and
alternate feeding when the baby is too frustrated or they can't get a
painless latch.

Usually with a little growth, these babies improve.  Some tricks that
have worked in my practice:
-when breastfeeding, bring baby's belly to mom's ribcage under the
contralateral breast, so baby is coming to the breast a little
diagonally to bring the chin into the breast better.  It's an
asymmetrical latch with  the entire baby's body slanted so that the
forehead is furthest from mom's trunk and the belly is closest.
- try the mini Haberman feeder for the baby initially, and then switch
to the regular Haberman as the baby learns to tolerate the nipple on the
palate.  (I suspect that short tongue can't get to that posterior
palate, and the palate is naive to stimulation, so it needs gentle
education...)
-monitor mom for vasospasm.  sometimes these kids gum the breast and
bruise the areola, other times they clamp on the nipple with their jaws,
causing reflex vasospasm.  Either one is enough to make mom want to
quit.  Vasospasm can be treated medically to "break the cycle" of pain.
-nipple shields might or might not help the baby latch better, they are
worth a try.

It's always hard to be consulted after the milk supply is already shot.
Sigh.
Catherine Watson Genna, BS, IBCLC   NYC

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