Remember that the tongue shapes the palate.  The problem with a baby
with a high palate is not so much the palate as the restricted little
tongue that failed to get up there and spread that palate in utero.

So, I'd look for a tongue tie or an anterior attachment of the frenulum
secondary to a short jaw in a baby with a high palate, and work at
getting more tongue attachment to the breast and a deeper, asymmetrical
latch to allow this baby to feed despite the tongue restriction.

As far as the initial bottle question goes, I have observed this:  any
baby who cannot make the breast work is more likely to make the decision
that it is not worth trying.  If we can make the breast work for these
babies, they will usually be happy to take it, whether or not they have
had bottles.  I usually prefer fingerfeeding babies with tongue ties if
they can't take the breast initially, since ff is suck therapy.  But if
the mother's nipples compete well with the bottle (everted), I might use
a bottle instead if mom is overwhelmed or does not want to fingerfeed.
It's the moms with flatter nipples that sometimes have a harder time
wooing their babies back from the bottle.

Hope this answers the question.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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