If there is anyone here (any OTs out there?) who can
share insight with me on techniques for helping a baby
learn to extend his tongue? I am at the end of my
expertise and would really, really appreciate some
advice. I would like to refer the parents to see an OT
but (1) the Pediatrician advised me that the health plan
would not reimburse the parents for the visit, and I
don't think they can pay (2) the OT I called (the only
one I know of locally) has not returned my calls
(vacation?)

This baby had a very tight tongue tie; it was clipped at
day 4. Now the baby can bring his tongue just over the
lower gum line. The parents did not come for a
followup visit as scheduled after the procedure,
believing the baby was doing ok. At the two week
check the baby had lost 10 oz. and then the mother
developed mastitis. I was called to the "train wrecks"
both times, but parents did not follow up with me :-(
However, at week three I started working with mother
and baby. He bunches his tongue and cannot draw the
breast into his mouth. He tries... He is resolutely
attached to a small Nuk-type pacifier and the mother
has resisted advice to stop use; she is under lots of
pressure to keep the baby quiet (student housing with
thin walls, husband trying to study, in-laws visiting...)
and feels the pacifier is a necessity.

When I first observed him he was having difficulty
maintaining latch on a Nuk-type bottle nipple. Ditto the
straight nipple. I started him on a Haberman. On
follow-up three days later he was doing well using the
Haberman and is now able to suck with his tongue
cupped along the bottom of the nipple. He attempts
latch at the breast but gets very frustrated; I have tried
all of the tricks I know of (positioning, flat nipple holds,
breast sandwich, even pushing a finger under or over
the nipple to assist him). We used some of the classic
"walking back on the tongue" techniques, as well --
and the baby seemed to enjoy this activity--he seemed
to be concentrating on the sensation. He just can't
seem to get his tongue down and forward sufficient to
draw in breast tissue. With a nipple shield he draws in
the nipple but sucks the shield in-and-out because his
tongue is not dropped underneath and his mouth not
open sufficiently to obtain a latch.

I have read through all past relevant Lactnet posts and
tried many of the suggestions. The mother wants to
breastfeed this baby and has a great supply (she's
pumping). However, she is getting discouraged.

Do you think it would help to use a longer pacifier, if I
can't get the pacifier use discontinued? I can see that
he bunches his tongue against the back of the short
Nuk-type and I was wondering if a longer one would at
least encourage him to keep his tongue down? Maybe
I need to advise the parents it is in their best interests
to seek out (and pay for) the services of an OT? Or (I
am hoping) might this be a case that will resolve with
time -- and growth?

As I said, any advice welcome...

Margery Wilson, IBCLC
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