If the posterior tongue is humping strongly, it's likely that there is a posterior tongue tie. They can be treated just as easily as the obvious ones, with a little snip. There is a little more bleeding, and the mucosa opens up into a surprisingly large diamond shape, and heals without suturing. It shows how much restriction was really there. One can get some clues to posterior tongue ties from watching the tongue, and the most common sucking pattern is retraction humping and biting, since the gums become exposed and trigger the bite reflex. Another possibility from what you describe is the uncoordinated pistoning movement that some kids with neurological issues use. I've seen some children with genetic disorders (including Prader Willi and Phelan McDermid syndromes) that used that sort of motion. An occupational therapist may be able to help, or you could try some of the standard "suck exercises" used by lactation consultants. You'd want to see first if the baby accepts oral touch, if so, then you can use some stroking along the midline of the tongue to encourage extension/protrusion; and perhaps "walking back on the tongue" to encourage peristalsis. Central grooving is very important to maintaining the breast in the mouth and for bolus control no matter how the baby feeds. A tug of war game with a long cyllindrical pacifier might help improve central grooving and tongue strength. The Breastfeeding Answer Book has some good ideas, as do PreFeeding Skills 2nd edition by Morris and Klein (available from Therapy Skill Builders, www.psychcorp.com) and the classic Feeding and Swallowing Disorders in Infancy by Wolf and Glass (ditto on the publisher). Well, that's my three for today and it's not even 7 am, so I quess I can get back to work! Catherine Watson Genna, IBCLC NYC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html