I have been out of state teaching, so this is a delayed response to
Jessica's query about the baby with tongue-tie who also was discovered to
have a cleft of the soft palate.  Tongue-tie is a mid-line defect, and is
often found in association with other mid-line defects, or as part of a
syndromic cluster of problems.  Soft palate clefts are profoundly going to
affect breastfeeding.  First, there is a complete interruption of those oral
muscles (the soft palate is a muscle that has to have good tone and function
in order to help the tongue seal off the rear of the oral cavity to protect
the airways during swallowing.)  Secondly, in order to create suction you
must have a sealed space.  The hole in the palate is like a popped balloon:
all the air rushes out.  This means that the infant cannot use normal
suction to draw in and hold the nipple in the mouth.  If the nipple slips
back, then the sensation of the nipple just touching the tip of the tongue
triggers a thrusting reflex.  This is normal.  If you want to elicit a
tongue extension you tap the tip of the tongue.  The ENT is ill-informed, in
this case, about the mechanics of breastfeeding and doesn't understand how
much interruption the cleft is causing.  The baby may become more adept over
time at switching to a jaw compression maneuver to milk the breast, but will
need lots of early help to overcome the weak tongue, cleft issues, and
perhaps even more undiscovered physical problems that may affect stamina for
feeding.  I would strongly recommend lots of pumping to protect the mothers
milk supply as exclusive human milk feeds are the only way to protect
infants with clefts from chronic glue ear (ref for that below).

J Paradise, et al:  Evidence  in infants with cleft palate that breast milk
protects against otitis media, Pediatrics 1994; 94(6): 853-859.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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