Breast milk has truly filled in the gap.  Speech therapy may eventually help, 
but this baby would also benefit from feeding therapy.  Depending on where 
you live, this would be by an SLP, PT, or OT.  Many are trained to do feeding 
therapy with elderly stroke patients; it would be best to find someone who 
works with children (who works with special needs? the local NICU might 
know).  They will work on desensitizing, strengthening chewing muscles, etc.  
His frenulum should be checked, because if the tongue isn't working properly 
the baby will be unable to move food from the front to the back, and gagging 
often follows because the timing of the swallow feels "wrong" to the baby (a 
protective reflex).  This baby's history of latch and  breastfeeding issues were 
probably early warning signs.  What was thought to be nipple confusion was 
likely a disorganized suck--also an early warning sign.  Encourage her to find 
the right help so her baby can enjoy eating.   
Amy Peterson  IBCLC

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