Hi Brenda,
I know this is a very late reply, but I wanted to put in my two cents.

Sounds like there is some restriction of tongue elevation going on in
this baby.  Normally, the tonguetip elevates first, to trap some milk in
the breast against the palate, and then the peristaltic wave follows
backward to about the midtongue, pushing milk toward the nipple.  Then
the posterior tongue drops a bit to collect the milk that sprays from
the nipple, which the baby organizes into a bolus and swallows.  After
breathing, the suck:swallow:breathe triad repeats.  (Actually, there is
some controversy in the literature as to whether the swallow occurs in
the middle of a breath, or after exhalation).

If there is restriction of the anterior tongue, say from a tight lingual
frenulum, the anterior tongue cannot lift, so the peristaltic wave often
starts posterior to the tongue tip. This might be the mid tongue
elevation that you feel during the digital suck exam.  During the
attempt to press milk out of the breast, the frenulum is stretched, and
causes recoil of the tongue, which rapidly interrupts the seal (negative
pressure) in the mouth, causing the clicking sound.  It can also cause
the baby to fall right off the breast, often many times during a
feeding, especially as the breast gets softer as the feeding
progresses.

It's also harder for the baby to groove the tongue longitudinally when
the tongue tip is tied down.  Try grooving your tongue while your tongue
tip is behind your lower incisors - can't be done.  This causes poor
bolus handling, and a gulping, gasping baby which is often diagnosed as
"overactive MER".  Sometimes it is, but just as often, it's the baby's
problem with normal flow.
Postural alterations to help the baby nurse uphill are often helpful,
whatever the cause of the difficulty keeping up with the flow.

Anyway, I could go on forever here, about the compensations babies use
such as substituting compression from the jaws for their restricted
tongue movements, but the take home message is that with a good mouthful
of breast so the tongue does not have to elevate as much to press the
breast against the palate, an asymetrical latch to maximize tongue
contact with the breast, and positions that help baby handle flow
(having mom lean back in a recliner, for example), many tongue tied
babies can breast feed well, despite the noise.  If they can't, or if
they are obviously struggling despite optimal management, then a consult
with a physician or dental surgeon who performs frenotomies is
indicated.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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