Robin,
What is the baby's respiratory pattern like? Does the baby have a very 
short mandible (lower jaw)? Two major reasons for persistent tongue tip 
elevation are short jaw (tongue doesn't fit in the lower one) and fixing 
the tongue to the palate to stabilize the airway. Babies with 
laryngomalacia might do this, kids with a very short jaw or large 
tongue, or other airway instabilities. Laryngomalacia/tracheomalacia 
take a few days to fully manifest, so if one of those are the case, the 
baby might have seemed fine in the hospital, but might be struggling a 
bit now. Did you note any stridor (high pitched squeeking noises during 
feeding)? Did the baby suck in short sucking bursts (3-5 suck, then stop 
for a long breathing break, with faster than usual or louder than usual 
breathing)?

What to do depends on which it is.

If it's just habit, mom can gently tickle the tip of the tongue with a 
clean finger a few times before positioning the baby at breast. Make 
sure to get the baby's chin planted firmly on the breast, and let mom's 
nipple come to his philtrum (the little ridge between nose and upper 
lip). This will get the best gape. Then let the baby do all the rest. 
Sometimes having mom lean back so baby is more prone brings his hyoid 
forward more, and will allow better mouth opening (the tied tongue pulls 
on the hyoid, and can reduce jaw opening).

If it's respiratory, helping baby come to breast in a way that will 
cause his head to be well extended can help. Sidelying is great for 
promoting extension, which works well for short lower jaws as well (and 
a short lower jaw restricts the airway a bit too.).

Catherine Watson Genna, IBCLC  NYC

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