In response to the advice to massage the mandible. Be very gentle with the massage. Deep or firm massage causes the muscles to fire increasing tone. You are trying to decrease tone so use very little pressure, if any. A gentle brushing is more in order here. As for pressing down on the chin, although it may help to bring the tongue down and forward over the lower gumline in a hypotonic baby, it may serve to do the opposite in a normal or high-tone baby. Firm pressure will encourage the muscle to contract. The mentalis muscle is one of the muscles that will respond to this chin pressure and when mentalis tenses so will orbicularis oris (the sphincter fibers around the mouth) which will cause the tongue to retract behind the lower gumline. It is my opinion that unless a particular LC has mentored training in the use of these therapeutic techniques, she should leave this kind of work up to the PT, OT, NDT or speech therapist. We can do more harm than good if we start messing around without understanding the full implications of what we're doing. I have seen my share of babies with aversive behaviors at or to the breast because they were "messed with". Please be careful. Alison Hazelbaker, Off to learn the Neonatal Oral-motor Assessment Scale and PT approaches from Marjorie Meyer-Palmer in early November. Want to come?