I have permission to post on a client I am working with.  I believe that this 3 wk old baby 
has a type 3 or 4 tongue tie.  Mom does not have pain but did in the early days.  I just 
began working with them this week.  Baby can briefly extend tongue slightly past gums but 
rarely does and when she is crying with mouth open her tongue stays on the floor of her 
mouth.  I couldn't really lift the tongue to even visualize the frenulum.  I would expect her 
palate to be higher and domed but it is not.  It is actually relatively shallow.  Even when I 
help to get a deeper latch baby doesn't stay open wide and seems to tuck bottom lip in and 
overly-flange the top lip.  She is pretty content to keep hanging out and breastfeeding like 
this but has very small milk transfer and is fussy when not on the breast.  She did go to the 
ENT clinic here and they said there was no problem or at least nothing for them to do.  I 
have read Catherine Genna Watson's book.  I guess my question is really about the fact that 
her palate does not match what I am seeing of her tongue movement.  Does anyone have 
any comments about this case?
Amy Slotten, RN, IBCLC
Ann Arbor, MI

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