This could be velopharyngeal insufficiency.  This is when the soft
palate is not large enough or strong enough to completely close off the
nasopharynx during swallowing.  It can be the result of hypoplasia of
the velum (soft palate), a submucous cleft (occult or overt), or can
occur after a cleft palate repair.

Interesting that it just started happening.  Did this little guy have
difficulty breastfeeding initially?  Another baby in my practice was
just diagnosed with this today.  I suspected it when his sucking pattern
  seemed to indicate respiratory distress but he did not have any
cyanosis or stridor.  He had harsh respiratory sounds, mild tachypnea,
sucked in very short bursts, was fussy at breast when the flow was high,
took a few weeks to be able to suck efficiently, lost milk through his
nose during some feedings and about half the time when he spit up.  He
was able generate negative pressure while sucking on my finger, and he
did has a very high palate, short mandible, and hyperresponsive gag
reflex.  His mom let me take a video of him nursing, which I just
incorporated into my "anatomy and sucking skills" talk.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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