I agree with the two other posts that have been written about protecting 
the milk supply, healing the nipples, and craniosacral therapy for the 
jaw clenching or looking for tongue tie (especially a posterior tongue 
tie). I would add that I do not think the pressure on the jaw is good. 
We used to do that before we knew that such things as CST would help 
more. I have never seen that pressure on the jaw during feeds does any 
good. Although our textbooks used to recommend this, and some may still 
do so.

I find that when a baby is a jaw clencher, without a tongue tie issue, 
he is also tight on wide based bottles. If you use a wide based bottle, 
baby should be able to put his lips on the fat base of the nipple. Not 
up to the fat base with a tight mouth, like a fish lips. I also look at 
how the lips grip on the wide based bottle. Sometimes it is obvious one 
lip or both do not hold onto the nipple properly. If you look at the 
paper included with an Avent bottle (the photo might also be on the 
carton it is packaged in), you will see the baby latched onto it 
properly (wide lips on the base). The calloused lips sound very 
suspicious to me like baby is using his lips to hold on or to milk the 
breast instead of the tongue or something else working correctly. I 
would also look at the latch and the corner of the lips should be a wide 
U, not a V  -- corners of lips not touching.

You can also look at the baby's body tone, although at this slow weight 
gain he may be weak. Watch if his hands and arms relax or if he stays 
tense and tight. Look at if he arches back from the breast. I find that 
CST helps with tight toned babies. If you are not seeing jaw clenching 
or tight tone issues, failure to open wide is often a sign of tongue tie.

About the weight gain, I would expect a baby who is 3 1/2 weeks old to 
be 9-12 ounces above birth weight. If you round up to 8 lbs, the baby 
needs about 20 ounces of milk per 24 hours. A 2 ounce feeding might be 
okay if the baby is eating 10 times in 24 hours. I would also expect a 
bigger intake, maybe 3 ounces but some babies self limit if they have 
reflux type issues. If this was the "best" feeding of the day, 2 ounces 
is low. If this was a "sleepier" than normal feeding, this might be okay.

What I usually see with oral motor issues is that baby can only remove 
1-1.5 ounces at the breast, no matter how much time or sucking baby does.

Kathy Eng, BSW, IBCLC

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