Hi Joanna
I wonder about a lip cleft. I only saw bilateral lip clefts once, I think they are no 7 clefts. Babies with clefts frequently
have nose involvement. It may be a cleft lip with muscles not appropriately attached in spite of the skin superficially
looking normal. 

If there is no lip seal this in itself can be sufficient to cause loss of negative pressure and make milk transfer difficult, 
there may also be more clefting. You say that the hard and soft palate look normal. A bifid uvula frequently indicates a
submucosal cleft, also some  ridging on the bony hard palate.

 Babies with submucosal clefts in general can create enough pressure to breastfeed though. Does this baby have milk coming through the nose at any time during feeding as that will be a sure sign of poor functioning of the soft palate which may be as result of a cleft.

Check the gums for any signs of abnormality, also the pre palate i.e. the tri-angular area in the midline behind the gum on the maxilla. 

This site shows the different clefts of the face that can occur.  http://www.cleftline.org/docs/tessierinfo.pdf

The baby I worked with also had a cleft palate, but her sucking improved dramatically when we were able to close off the lip clefts and this was done by putting pressure on the tissue below the clefts, in the same way that mothers with cleft lip babies use their fingers or breast tissue to close off the cleft.


If it is a cleft the baby will need referral to your nearest cleft lip and palate team.

Loraine Hamm
SLT/IBCLC
New Zealand

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