Clefts of the soft palate can create feeding difficulty.  The soft palate is
a muscle.  The soft palate and the posterior tongue press together during
swallowing to seal off the airways from the food being swallowed.  A baby
who has a rift of this muscle can't seal off, and safe swallowing is
difficult -- hence all the nasal congestion you hear (the result of
aspiration into the nasal pharynx).  The baby rapidly becomes exhausted, and
perhaps apneaic trying to maintain respiratory status when swallowing is
this difficult.  If you have to pick food or air, air is always going to
win.  Consequently, the baby Melisa describes may well be having significant
difficulty obtaining enough to eat before he runs out of breath.  Post feed
pumping and delivery back to baby of hind milk may well be appropriate.
Changes in feeding position may assist to see if one can be discovered that
will allow for better intake with less aspiration.  Deep breast compression
can assist, but must be done while observing to see if the changed milk flow
worsens the child's ability to coordinating breathing with swallowing.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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