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

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