Look under the tongue, uncoordinated tongue movements and inability to 
keep the tongue over the gum while sucking is one hallmark of tongue 
tie. Torticollis can also cause traction on the muscles of the face and 
neck and that may reduce tongue or jaw mobility, which can lead to jerky 
sucking. There are various supportive techniques that can work if the 
baby has torticollis. You can see Supporting Sucking Skills for 
sublingual support, and jaw and cheek support on my website (click on 
'clinical corner').

IMHO, babies generally do as well as they can. This mom can consider 
switching breasts right after the baby exhausts the first MER so that 
the other breast is still 'full' (MER pushes milk back down in both 
breasts, but the milk moves back up if too much time passes) when the 
baby gets it. Frequent feedings may be enough, or mom may need to 
express and give additional milk either at breast or after breastfeeding.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

On 6/9/2014 7:38 PM, Allyson Michaels wrote:
> I have PTP. fFirst time mother called last week for an appointment for her 4 week old. When she came in and I asked what brought her in, her response was "my baby sucks on my breast like she does on a bottle". Oral exam within normal limits. Tongue movement though was not coordinated. She would pull several times and then her tongue would be behind her gum. Mother had been supplementing within days after delivery for weight loss. She has continued to supplement and pump after several feedings a day. She breastfeeds every 2 hours, says the feeds take almost one hour and does not hear frequent swallows. Infant gets 1-2 oz in the am, 2-4 oz in the evening by her or her husband. Husband tends to give the 4oz as he feels that his daughter should not be hungry. Infant gained 1oz a day in the 1st 2 weeks and in the last week, gained 1/2oz a day. Mother pumps after her am feeding and gets up to 5 oz and in the evening 2 oz. Mother had an uneventful delivery and had an epidural for only a few hours.
>
>
> At the breast, this little girl did have  a vigorous suck with pulls for the first 5-ish minutes. Then her suck became more irregular-like what I felt on my finger. Mother's breasts were dripping milk. Breast compressions did elicit more swallows but overall, not much different. Mother was unaware of some of the swallow sounds. They were not gulps but were 1-2:1 sucks to swallows at first and then rare. Intake at breast was slightly over 1oz after 15 minutes in a pre and post feeding weight.
>
>
> My impression is that this infant has learned to live the life off mother's MER and then does not pull to work the breast after that. I encouraged her to try pumping more frequently and I placed a call to her peds to see about an OT/PT/speech pathologist consult for suck training. I tried to look in the archives for nipple types that would be more helpful for her but have not been able to access. She is currently using the Dr Brown's and I instructed her on pacing the feedings. She said she tried the Breastflow bottle but the infant did not like it. Did I read on this list that the Breastflow would make her work harder?
>
>
>
>
>
> Any suggestions?
>
>
> TIA,
>
>
> Allyson MIchaels, RN, IBCLC
>
>
>
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