I agree that tongue elevation is much more important than being able to 
stick the tongue out for proper sucking at breast.

It is fairly normal for babies with respiratory challenges to lower 
their sucking pressure to slow the flow, Mizuno verified this in babies 
with bronchopulmonary dysplasia. So there might be more than one thing 
at work here.

We won't really know what's up with the baby until mom has a more normal 
flow. How about her pumping each breast half way and then letting the 
baby nurse so you can see how she handles slower flow? Then if there's 
still a lot of clicking and popping, you can look at the tongue and the 
soft palate (velopharyngeal insufficiency can also cause popping sounds, 
though it's usually silent, there's just more wet breathing during/after 
feeding).

Catherine Watson Genna, BS, IBCLC  NYC

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