What about the role that the tongue plays in *milking* the breast?
This is something that I have not yet see addressed by those who
favour of one type of  teat/bottle over another. It is my
understanding that when being bottle fed, a baby will thrust her
tongue forward to block the holes in the teat to prevent the milk from
flowing too fast. In my experience it is the difference in tongue
movements that often complicates a baby's transition from bottle to
breast.

Norma Ritter, IBCLC, RLC

Norma, when I look at the tongue sometimes on a bottle, I see it out to 
the gum and cupping the nipple like it should be on the breast. This is 
not scientific but I will look at those babies I think are tongue tied 
or weak sucks, etc. and need supplements. If mom is already using 
bottles or we have to find the quickest/easiest/most effective method to 
supplement, then I often look at where the tongue is. I used to hear 
that bunching to stop the flow, but I am not sure this is correct. I see 
more jaw compressions and actual lack of sucking on bottles. You see 
swallowing. This is why I think the bottle fed babies I work with do not 
suck at the breast. They might latch but they do such ineffective 
sucking that they get nothing. On bottles, too much sucking makes the 
flow too fast. What I observe is that they will suck maybe 3-4 times at 
the breast and come off crying. This is not enough to transfer milk. If 
we go to supplementing at the breast, many will swallow the liquid but 
still not suck (unless we get lucky and they start sucking). This is my 
theory based on watching these bottle fed babies struggle to breastfeed.

Kathy Eng, BSW, IBCLC

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