A recent post indicated that tongue tie had been ruled out because the baby was able to stick its tongue out.  I wonder if this is proof enough.  I have seen infants that can extend the tongue, but not keep it extended.  I describe it as if the baby had a rubber band fastened to the tip of the tongue that kept tension on the tongue so that it tends to retract without effort to keep it out.  When the tongue "relaxes" and then retracts, the infant extends it again,it retracts, etc.  This repeated extension and retraction would seem to be one cause of pain-basically "friction burns" from the tongue repeatedly rubbing on the nipple instead of remaining extended and groved.  I saw a number of cases where the evidence on mom's nipples seemed to point to tongue tie.  However, when this was reported to the doc, the response was,"No it;'s not because the baby can stick its tongue out."  However, digital assessment of the suck showed the repeated in and out motion which to me said that while baby was able to extend it, he didn't have the ability to maintain that position.
Goes to show that assessment needs to be more than a "snapshot" of a feeding.  We need much more in depth observation.  This is something that, unfortunately and not always their fault, most docs don't have time for in their newborn exams both in hospital and office.

Winnie

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