The eyes may be farther apart than usual (ocular hypertelorism)
the nose may have bony bulges on either side (paranasal bulging)
there may be a notch in the vermillion of the upper lip in midline 
(gullwing deformity)
the hard/soft palate junction may look irregular rather than oval and smooth
a light shined in the baby's nose may be visible inside the mouth
if you make the baby gag, you may notice the cleft if there's one in the 
soft palate, or you may see a bifid (split) uvula.

While submucosal clefts are not the most common cause of difficulty 
coordinating swallowing and breathing (inexperience with fast flow is 
one, tongue-tie is probably the second most common, other respiratory 
issues are up there too (laryngomalacia, tracheomalacia); they are 
important to recognize because they can cause milk production to dwindle 
over time.


Catherine Watson Genna BS, IBCLC NYC cwgenna.com

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