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Background: 4 WO baby who was induced for GD at 39 weeks, vag. birth after 3 day labor. Has gone to breast several times and a few times has drawn milk accding to Mom. Most of the time he does not latch deeply and it hurts her and he is fussy at breast unless a letdown is elicited by compression. She is pumping and feeding mostly by bottle. They are just getting over thrush. 

Exam today: His tongue does have mildly restricted movement, but not as much as I've seen with most tongue ties. When he cries, his tongue does rise about 3/4 of the way up to his palate, almost as far as in K. Genna's book p. 184, figure 8- 4, but is a little flat on the tip. Also his palate is not high or narrow. He doesn't seem to lateralize his tongue much at all when I try to elicit that response. He can't stick his tongue out over his lower lip- the tip goes down between lower gum and lip. Suck exam- grooving minimal, no wave-like motion noted but then I wasn't using a feeding tube so maybe that was due to lack of flow. No assymetry noted. 

Question: Could it be tongue tie without effects on the palate and even though he has fair tongue tip elevation when crying? 
I did recommend a Ped or ENT for TT and  also considering CST. Thank you, 

Mary Taylor, IBCLC

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