Jennifer T wrote:

<<the baby also seems very unhappy.  Baby seems to slide off on to the nipple
frequently, struggles to maintain latch, and cries a lot at the breast.  He
also does poorly with a bottle, seems to gag a lot, and is just generally
unhappy when feeding all the time.  He does not spit up at all, and breathing
sounds normal to mom.  Weight gain has been good (8lbs 2 oz at birth, 11 lbs in my
office at 5 weeks.)...  the tongue was simply  attached at the base.  He did
have a recessed chin, high palate, and short  tongue.  When sucking on my
finger, he did not protrude the tongue over the  gum at all.  If my finger touched
the back of his hard palate, he gagged and
 looked miserable. >>

It seems that many babies who can't feed normally and successfully at breast
also do poorly with a bottle. They look like they are working hard not to
drown, may gag, evidence of poor tongue, cheek, lip, and/or jaw control, poor
bolus control, etc. The mother and you have smartly recognized this, while the
pedi is looking only at weight gain. There are many wise women on LN, but I would
start with what little I know: babies with more than the usual recessed chin,
lack of tongue being able to extend over  the bottom gums ( I am staying away
from the word "protrude" since OTs  and SLTs who work with feeding issues
often use that as a term for the tongue sticking out abnormally and often due to
low muscle tone) and a high palate, are at a true mechanical disadvantage
during feeding attempts. The smaller or more recessed jaw can mean less jaw power,
the lack of tongue extension can mean less power to  draw breast tissue in,
and strip milk out, and can go hand in hand ( tongue in tongue?) with a poorer
ability to trough the tongue, and control the little boluses of milk, which
can then lead to sloshing, gagging, crying, overall fatiguing out or shutting
down. The high palate also means that lower powered tongue has to go even
further "up" on its peristaltic wave to compress breast tissue and strip out milk,
but if it can get to the top of its little arc and manage it, the milk that
comes out might still be poorly controlled due to the lack of tongue
power/control/length. Poor mom and babe working so hard, but at least mom knows she is
really seeing what she KNOWS she has been seeing. I use the analogy that there is
nothing wrong with their baby's anatomy, it's simply like having  family
members or friends where one has long legs and the other naturally shorter. They
go for a walk together.  The person with the shorter legs can get there, but it
takes more energy to keep up, and  may take patience by the other person
walking with them. Does that make sense?
Just some quick thoughts for now...
Judy LeVan Fram, IBCLC, Brooklyn, USA

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