Tongue thrusting on bottle, breast, and pacifier is a way to get pedi to 
"allow" consultation with an SLP. Tongue thrusting is the reason this 
baby is not latching. Or so it seems to me. I keep the baby at the 
nipple with the nipple in the mouth or on top lip over and over until 
the baby stops tongue thrusting. I have had some success using the 
nipple sandwich technique and holding the breast tissue with my fingers 
until the baby starts to suck right and get going. If you let go too 
fast, baby seems to pop back off. (This is a time when I am hands on as 
I need to do this first to see if it is going to work.) Or I might give 
a little bit by bottle and try to get the tongue thrusting stopped. I 
sometimes use a periodontal syringe at the breast to hopefully stop the 
tongue thrusting. (Another time when I am hands on as I want to be the 
one doing the supplementing first to see is this technique is going to 
work and how much flow is needed.) I have tried having baby suck on my 
finger first. Sometimes what works is the milk or supplement flow stops 
the tongue thrusting. Some babies never stop tongue thrusting. Mom keeps 
sore nipples if baby will latch and remove milk. Tongue thrusting is 
totally backwards for removing milk at the breast which is why this baby 
had so much weight loss or poor gain. I would mention that to the pedi 
in your HCP report. Or say you suspect this. I never come out and say 
this is exactly why as I am not an SLP. Nipple shields do not work with 
tongue thrusting because baby "bobs" back and forth on it and this is 
very ineffective. Test weights usually show less intake with tongue 
thrusters on a nipple shield but sometimes it works. When I try the 
nipple shield and I see baby go back and forth on it (sliding out and 
sliding back in), I suspect tongue thrusting. I do not use the nipple 
shield if the baby is bobbing back and forth on it. I do not really  
have a solution to this, but it is an oral motor issue.

Kathy Eng, BSW, IBCLC

PS: I only work with really bad babies so I am more hands on at first. I 
put my hands on moms hands and guide her to where to hold baby and how 
to latch properly. But she is doing it. I am not holding the baby. She 
is. Then the next latch on, mom tries to do it herself. And I give 
verbal instructions. With good babies, I explain or show correct 
technique and have her do it.

My opinion is that if your technique really frustrates the mother, then 
try something else. If your technique empowers the mother and makes her 
feel good, that is the right approach. I think about some of the tongue 
thruster babies and the oral motor problem babies and mom knows how to 
latch on but it either isn't work or isn't quite good enough. I have to 
get in there and try different things but the goal is to have mom try 
herself several times to be able to do it next time. I do talk about 
what I am doing and explain everything I am doing while I do it or 
before. And ask permission to touch mom and baby first.

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