Hi Marie,
I suspect the following scenario here:  Baby has a hypersensitive
mouth/gag, so refuses to pull the breast to the junction of the hard and
soft palate, and chews the nipple, forming that nice little pocket in
the palate, which reinforces the poor latch since the nipple fits there
so well.  The poor latch causes the tongue to be unstable (because the
mouth is not full of breast), so the suck is lousy.
        If the root of the problem is truly a hypersensitivity, there is a neat
little trick some OT's use:  before feeds, put firm pressure on the
posterior surface (inside) of the upper gum with a finger, then slide
the finger slowly back along the palate as the baby accepts it.  The
firm pressure to the alveolar ridge seems to increase the ability to
tolerate oral stimuli.  In this baby, the proper area is probably the
front of the bubble...  The mom can do this while fingerfeeding, as food
increases the acceptance of stimulation as well.  Then move to the
breast to end the feeding.  Some kids need only a little bit of
fingerfeeding before they can move on to sucking well at breast.
        Also look for a tongue-tie, not your typical tight at the tonguetip
one, but a restriction farther back that allows freedom of movement of
only the tonguetip, but not the main body of the tongue. This is another
scenario for bubble palate formation, when the baby elevates the
tonguetip against the front of the palate, but can't get the midtongue
up there, so the only part of the palate that explands is the very
front.  I saw a very clear example of this today, didn't have the heart
to ask to take photos because mom was upset that I recommended they see
the doctor...hate that part of our job.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]