The thing that makes assessments so difficult is that there can be opposite reasons which cause the same thing. The bunching of the tongue in the rear of the mouth can be caused both by high and low tone. If the baby is hypertonic, the tongue may be PULLED into the back of the mouth by too much muscle tension and the tendency of the baby to arch back. If the baby is hypotonic, the tongue may FALL back. Wolf and Glass say that other small, weak, low tone infants seek postural stabilty through tongue retraction. I think that means they are tensing up the tongue trying to maintain head control. Increasing their postural support - esp at the shoulder girdle - helps them a lot. Even though this all seems contradictory, the big thing to know is that it is critical to find some way to help the baby, because if the tongue is not in the normal (extended and grooved) position, the baby can't control the bolus of milk, can't create sufficient negative pressure, and the position of the tongue may obstruct the phyaryngeal airway. The other big thing to know is that tone problems and feeding dysfunction in general are neurological soft signs. Typically babies will improve over time and out-grow or mature past these problems. Esp. if they are caused by birth trauma or meds. Asymmetries of the jaw, where the lower jaw is very recessed (over-bite) create problems with locating the tongue where it should be. It really helps to bring the baby to breast in a position which prioritizes placing the lower jaw on the breast first. Bringing the chin in closer to the breast will bring the tongue forward, altho you want to avoid extreme hyperextension of the head. Since the baby under discussion arches, bringing the head and neck into better alignment is an important starting point. Hip flexion will also assist in this. The arching suggests that hypertonicity (rather than low tone) may be the problem. PTs, OTs and Speech pathologists use gentle vibrating techniques to the tongues of babies with retraction due to hypertonia. They also recommend use of long nipples, which provide greater contact on the tongue and promote more effective tongue movements. I think I recall that there was a suggestion to throw away this infant's pacifier. Maybe the infant could profit from some judicious use of it -- esp. right before a feed to help increase the proprioreceptivity of the tongue. By the way, the Playtex nipple only appears to be short. If you suck on it, it extends to a much longer length than the Avent. I measured it with a ruler. I think it's too long, and like the length of the Avent better. Barbara Barbara Wilson-Clay, BSEd, IBCLC Austin Lactation Associates, Austin, Texas http://www.jump.net/~bwc/lactnews.html