Dear Friends,
Thank you for your responses. I have thought of the possibility of a 
submocous cleft for this baby, they don't have a full cleft,  and will 
be reexamining the baby tomorrow. Why the milk leaking now though? Why 
only one side if it is a cleft? That is why I am looking for other 
possibilities.
Any other ideas?
If it is a cleft, what do we do about it? I have never had a baby with 
one before, or at least one that was caught because it was making a 
difference. It seems as though the baby is doing well now so this new 
information will be interesting more than anything. I know it can effect 
speech later.
How do you best assess for it? I know to look for a bifurcated uvula but 
I find they are so hard to see in a small baby. I hate to use a tongue 
depressor! What are your protocols for this element of your exam? Just 
look at the uvula?
Another question, do you look for this in all babies or just the ones 
that are struggling? I feel it is an kind of an oral assault. If you 
find a baby has this issue and can't make a good seal, what happens? Is 
milk leaking always involved?
I have found this info: "A submucous cleft palate may be identified by 
the presence of a bifid uvula; a very thin translucent strip of lining 
(mucosa) in the middle of the roof of the mouth; and, a notch at the 
back edge of the hard palate that can be felt by the fingertip."

Thank you again for all of your help!

-- 

Barbara Robertson, MA, IBCLC, RLC
The Breastfeeding Center of Ann Arbor
bfcaa.com

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