Look under that tongue. The tongue shapes the palate, if the palate is 
high, narrow or otherwise unusually shaped, it is probably the fault of 
altered tongue mobility.

A subset of infants with altered tongue function use excessive pressure 
during sucking as a compensation. Sounds like this baby is one of them. 
Donna Geddes (formerly Ramsay) stated at the CLCWA conference 2 weeks 
ago that 10 infants using excessive negative pressure in her study 
reduced their sucking pressures when using a nipple shield.

I usually try fixing the latch first, to see if allowing the baby more 
autonomy (and more time to get the tongue in position) allows a deeper 
more comfortable latch. If that doesn't work, look at the tongue and see 
if there is a tongue tie, and if so, if mom can access treatment (some 
of the subtle partial tongue ties can be easily missed, and many docs 
are hesitant to treat them). If mom can't access help, she can try a 
nipple shield.

Catherine Watson Genna, IBCLC  NYC

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