High Palate= tongue does not get up there to spread it.  Reasons could
be tongue tie (even a far posterior one (type 4) can prevent tongue
elevation beyond the very tongue tip; short mandible (tongue is
generally so long in relation to the mandible that it is held against
the anterior palate rather than resting along the entire lower jaw and
over the lower lip); or short tongue.  With these conditions, even a
perfect latch will not lead to perfect sucking.  Sometimes the sneakiest
tongue ties (type 3 and 4 that no one ever notices) can cause worse
tongue retraction and chewing of mom than the more obvious classical
"heart shaped tongue" type 1.
Posterior tongue ties can be treated, often by simple frenotomy if doc
knows where to snip.  It's hard to get the pediatrician to go along and
let the mom have a referral to a specialist, because some of them don't
even "believe in" difficulties from obvious tongue tie!
Sigh.
Catherine Watson Genna, IBCLC  NYC

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