This sounds a lot like a baby in my practice who has Velopharyngeal
insufficiency (VPI).  VPI happens when the soft palate is not able to
seal off the pharynx, and the baby can't seal off the nasal cavity.  VPI
can occur when there is a submucous cleft palate, weak velar (soft
palate) muscles, neurological issues, or failure of the pharygeal walls
to come in toward the soft palate.

The baby I saw with VPI was unable to meet his needs at the breast for
the first few weeks.  He lost milk from his nose during feeding and when
he spit up.  We experimented with positioning and he did decently in
sidelying, and decently in straddle position with his head extended.  He
had harsh respiratory sounds without cyanosis, and had only very mild
suprasternal retractions.  He's never a happy camper, and feeding is
long and pretty miserable.  Mom uses a Haberman feeder on slow flow when
he cannot seem to make the breast work.

I only dealt with one other case of VPI - A former client had a
subsequent baby with this condition, and it took him a few months to be
able to breastfeed exclusively.  I only worked with her on the phone,
though, as she had moved to another state.
Catherine Watson Genna, BS, IBCLC  NYC

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