It is my opinion that bubble palates are (at least in part) caused by the failure of the tongue to shape and spread the palate in utero. Tongue-tie (where the tongue is anchored to the floor of the mouth and can't reach to spread the palate) is one possibile cause. I usually see bubble or high arched palate with ankyloglossia. Hypotonia of the tongue may be another reason. Breech position where the baby is wedged in a position which keeps the tongue down might also be implicated in palatal malformation. There are also a LOT of syndromic conditions that affect palatal development. I think clefts (of which these unusual palates may be 'near misses') are associated with close to 300 genetic syndromes. Perhaps the poor feeding ability often associated with these palate shapes is more related to the underlying syndrome -- some of which may be subtle or not diagnosed until the child is older. Kittie Frantz and I had a conversation about bubble palates recently. She says the same thing: When the palate is unusual, look at the tongue function. The palate shape can certainly complicate feeding because thinning the nipple against a bubble palate is like trying to roll pie dough on a table top with a hole in it. You can't get uniform compression. However, I think sometimes in our focus on the shape of the palate we forget to also assess the tongue. If it is weak, tethered, or patterning in some odd way, then it, too, is complicating the baby's ability to feed. Barbara Wilson-Clay BSEd, IBCLC Austin Lactation Associates http://www.lactnews.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html