Helen,
Sounds like the baby with the sting-ray tongue has a tongue tie in
addition to his short mandible and cleft palate.  It might not be wise
to release the tongue in this situation, because that might be the only
thing preventing respiratory distress.  Sounds like Pierre Robin sequence.

Perhaps the baby could latch on in prone, with his head extended to
bring the short mandible in.  An asymetrical latch is important with a
short mandible and tight tongue, to give as much tongue contact as
possible.  Mom might need to hold baby on by the shoulders, and can hand
express milk into his mouth.  She will need a hospital grade pump to
maintain a supply.  If he cannot generate enough suction for an sns to
work, she can deliver milk into his mouth with a syringe attached to a 5
french feeding tube.  This would leave her without a hand to do breast
compressions, but might work better.  She would get some stimulation
from his little mouth on her breast, but he would probably not move much
milk.  Mom could take advantage of this stimulation by pumping
immediately after feeding at breast.  Even if he does nothing more than
mouth the nipple, it can help her maintain a milk supply by pumping.
And please make sure she has the very best dual electric breastpump, I
like the Ameda lact-e best, but a Medela classic would also be
appropriate.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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