>>We've reviewed Marmet's Suck Training, significant portions of Riordan and
Auerbach, and the Neonatal Motor Assessment Scale.  Any words of wisdom?<<

You might consider doing a suck assessment with flow--- fingerfeed the baby,
and use a periodontal syringe or SNS to give milk at the same time and
compare sounds, appearance, feel.  I have also had one of these babies who
"looked" great from afar and even made convincing swallowing sounds, but
every time I tried to "peak" at the latch by the lips, the nipple slid right
out. This baby was a great actor, but never was drawing the breast back, but
rather was kicking it to the front of the mouth only. When I did a suck
assessment like this, the baby's tongue pressed my finger upward against the
palate and I started to feel a dull ache within seconds. Hard to discern
these things sometimes without feeling them!

-Lisa Marasco, LLLL, IBCLC
Santa Maria, CA