Hi Merilee,
I often see hyperactive gag with kids that are either tongue tied or
have recessed jaws, because tongue elevation is restricted, and they
cannot get the body of heir tongues to contact the palate.  Sometimes
they can get the tongue-tip up, and that's when I see a bubble palate.

I suspect that the palate is just not used to stimulation.

There are several issues here: helping baby handle milk flow (the tongue
often grooves less strongly when there is a tonguetie and this makes it
harder for baby to hold milk in the mouth until he/she wants to
swallow.); and helping baby tolerate having the breast in the proper
position in the mouth.

Babies are usually more able to inhibit the gag reflex when there is
food in their mouth, so if the baby is not doing well at the breast,
some fingerfeeding may be helpful, starting with the fingertip in the
bubble on the palate, where the baby is used to it, and gradually
advancing the finger as the baby tolerates this.

Helping baby handle flow can be as simple as having mom lean back
strongly so baby is almost prone, or sit baby at mom's side with lots of
support from firm pillows and mom's arm.  And if there is an oversupply,
working on that as well.

Check out the frenulum again.  Babies can bunch their tongues when they
try to elevate them if the frenum is short.  Try it yourself with your
tongue tip pressed to the back of your lower teeth.  If that's the
problem, frenotomy might be the solution.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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