Hi All,
I have been receiving Lactnet for a week now.  I am an IBCLC in private practice
in Queens county, NY City.  My special interest is suck, so I can't resist
answering Yaffa's question.
        Have you looked at what the baby is doing with her tongue?  I have found
that incremental latch on ("nibbling on") is often associated with tongue
retraction, often due to a short lingual frenulum ("tongue tie"), or habit due
to bottles, or to protect the palate or stabilize the airway, ad nauseum.  The
wedged nipple (like that term, hadn't heard it before!) is commonly associated
with tongue retraction at latch, as the nipple is never drawn far enough into
the infant's mouth to avoid compression by the anterior tongue.There are several
ways to observe for this:  1.watch over the mom's shoulder while she latches the
baby on, notice where baby's tongue is when she opens her mouth in response to
mother's nipple on her lower lip, it should be at or over the gumline.  Some
babies slip the tongue forward at the end of the latch, this is okay as long as
they do not hurt mom and are getting enough milk. 2.watch baby's cheeks during
sucking, with practice you can see the outline of the tongue as she sucks, it
should compress the breast with an up and down motion, not move from side to
side or slide from front to back; furthermore, there should be no dimpling or
collapsing of the cheek. 3. you could offer a clean, gloved finger to the baby
to suck by gently tapping her lower lip and seeing if she opens her mouth to
draw it in.  Tongue retraction is noticable, you should not feel the baby's
lower gum at all when she is sucking on a finger, if you do, or if she bites,
she is retracting her tongue.
        If this little one does retract the tongue, you can try getting her to
open wider by having mom gently tap her nipple on baby's lower lip; or
positioning baby in the football hold with mom leaning back and flexing baby
gently to bring her face to the breast (flexion assists sucking); or have mom
keep tickling the baby's lips after she opens her mouth, patiently waiting for
the tongue to be extended before pulling baby in to latch.  If all these fail, I
have had success with having the mom GENTLY tickle the tip of the baby's tongue
with a finger immediately before latching on.....details upon request.  have
already used up enough bytes!  Good luck!
Cathy
Catherine Watson Genna, IBCLC