I saw a baby with a challenging problem today, 13 day old, full term girl
whose tongue motions are very abnormal.  Global muscle tone seems low, baby is
totally unable to flex extremities against gravity when held by trunk in
prone.  Arms and legs hang limp like a premie. Oral muscle tone varied
markedly over time.  Baby elevates the tip of the tongue strongly in response
to stimulation.  Wants to get everything under her tongue.  Posterior tongue
also elevates periodically.  No evidence of ankyloglossia, in fact the lingual
frenulum was indistinct.  Most troublesome of all, at the end of each short
sucking burst, baby experiences tremors of the tongue.  Off the top of my
head, I might attribute some of these behaviors (variable suck pressure,
tongue tip elevation,) as compensatory "fixing" behaviors, but the tremor has
me very concerned.  This is not a starving baby.  Plumping out, gaining
weight, well hydrated, alert, content.  Was simply killing mom's nipples, so
mom is pumping some feedings and bottle feeding.
        I suggested some alterations to the latch on and positioning,
stimulation of the tongue before each feed to increase extension and decrease
elevation, fingerfeeding by dad when mom is sore: his huge fingers provide at
lot of stimulation to the tongue.  After taking 20cc from daddy, baby latched
and sucked more comfortably at the breast.  Hope he has a decent paternity
leave!
        Does anyone have any ideas about the origin of these tremors?
Anything I've overlooked?  The only non-ominous etiology I can think of would
be muscle fatigue if the baby is using fixing to compensate for low tone.  I
did give mom the number of a neonatal Physical Therapist, "just to see if she
can help too".
Thanks!
Catherine Watson Genna, IBCLC