Jaye,
You are not missing anything, you are describing some of the 
compensations babies use when their tongue is restricted by a tight 
frenulum, whether it is visible or submucosal.

One potentially helpful intervention is to fingerfeed expressed milk 
once or twice a day to give mom some relief, and use that time to help 
reduce some of the posterior tongue elevation that along with the tongue 
sliding is rubbing mom's nipple and abrading it. The finger can be 
directed downward and can pull the back of the tongue forward gently as 
the baby sucks, like you are trying to smooth out a wrinkle in fabric. 
You do not want to eliminate the tongue elevation, as some is normal 
during breastfeeding, you just want to prevent it from being excessive 
and squashing the nipple tip.

Can I mention the Gold 07 conference since I am not being paid for 
participating? It starts this week, and I am going to be addressing this 
topic (using fingerfeeding as oral motor therapy).

Catherine Watson Genna, IBCLC  NYC

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