Great observations, Kathy.

Sounds like this baby has a small or recessed lower jaw (mandible).
Beyond rules 1 & 2 (feed the baby & protect the milk supply), and
fingerfeeding or suck training to help the baby learn to keep the tongue
down, one thing I have learned to do with babies with recessed mandibles
is to extend their heads very slightly, and place the lower lip on the
mom's areola about 1/2 inch from the nipple.  This tends to: encourage
the baby to open the mouth widely to enclose the nipple (then mom can
pull him in to get a deep latch) and provide more tongue contact with
the areola, rather than allow the tongue to push the nipple out of the
mouth. If mom waits until the tongue is extended and is between the
breast and the lower lip before pulling baby in, it also helps prevent
the long tongue from displacing the breast.

        Excessive lip movement during sucking is a compensatory action that
infants use when the latch is shallow and the tongue is destabilized by
not having enough breast in the mouth.  You might also see this in an
infant with low muscle tone.  In some cases the tongue on the palate can
be related to low tone (as a way to "fix" the airway), or it can be
simply that it is too large to fit neatly in the recessed lower jaw, and
this posture has become habitual.  I also see a lot of tongue sucking in
infants with long tongues and short madibles.

        The difficult thing about this case is that there might be more than
just one thing going on...many kids with lowset ears have genetic
defects, and many genetic defects also cause low muscle tone as well.
Did the speech therapist say anything about the baby's muscle tone?
Perhaps a physical or occupational therapist could prove helpful if the
suck training/better latch don't help.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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