I have had a very interesting exchange privately with Dr. Page and am
interested to present some of his ideas to our neonatologists and
occupational therapist.  One other issue regarding palatal grooving is that
of positioning of the infant.

Premie heads are extremely soft and malleable.  The bones in the skull are
not fused.  They are supposed to be floating in a water-filled sack with no
pressure in any direction (although they can and do suck on fingers and
thumbs in utero). In years past, it has been common practice to turn premies
heads from side to side because it is so simple to position the ventilator
tubes to one side.  This has led to the typical narrow head and face of the
baby later on, and apparently to collapse, narrowing and grooving of the
hard palate.

However, in the last few years, we have been positioning babies heads in the
midline for several hours at least once a shift, and have seen a reduction
in the severity of palatal grooving, and narrowing of the palatal arch.
The question remains: How much palatal grooving in premies is due to
endotracheal tubes, to pacifiers or other NNS that is not the breast, and
how much to long-term side positioning?  I have a feeling that what goes in
the baby's mouth is not the only issue.  Has anyone ever done a study on
this?

Anybody care to comment?  Incidentally, our babies do skin to skin at 750
gms if they are stable on a conventional ventilator (not high frequency) and
NNBF at the breast as soon thereafter as the endotracheal tube is no longer
needed.  80% of our babies are still breastfeeding 3 months after discharge.

Thanks for sharing,
Deanne Francis, R.N. IBCLC
NICU

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