I took a look at the website that was recommended and unfortunately, it
did not really address the issues that the younger infant has with a
submucosal cleft palate (SMCP).  I think because I work with both
breastfeeding and bottlefeeding babies, I probably see more of this than
the typical IBCLC.  I am very lucky and fortunate to work with other
disciplines with feeding related issues so I am always learning and they
very much enjoy learning about lactation as well.  SMCP is many times
very difficult to diagnose, there is not always objective data with exam
such as a palpable notch, absent uvula or bifid uvula and the website
does note.  There may be... but not always.  many times, I see the issue
initially brought to attention due to poor weight gain, difficulty with
breastfeeding even though mom feels it is going well, eventually a low
milk supply due to hx of poor milk transfer.  It may be that there is
only a weak suck and no other organic issues such as neurological,
medical or observable anatomic anomalies.  Finding other feeding experts
that tend to be supportive of breastfeeding is a good first step and
then finding ones that have a good lactation knowledge base to help the
breastfeeding moms and babies.  It is a definite possibility with a
SMCP, that there just is not a way for the baby to create the level of
suction needed to transfer enough milk.  There would be several
lactation related measures that I would suggest to increase success at
the breast:  could mom create an overabundant supply to make let down
and milk transfer easy for the baby?  Use breast compression or massage
to increase milk transfer.  Switch nursing along with breast
compression/massage for a minimum of each breast twice to ensure getting
to hind milk and limiting nonnutrtive time at breast.  It is very easy
for a baby with weak suck to fatigue due to long feeding times that
yield inadequate amounts.  You can refer to Jack Newman's videos on
compression and active swallowing.  No limit on how many times of going
back and forth.  I would not recommend a nipple shield for this
situation, it will not encourage a big wide asymmetrical latch nor will
it increase the suction.  Chin and or cheek support would also be
another measure but is more difficult with latching at breast, think
Dancer hand position.  A multidiscipline approach would be great!
Angie Kirkwood RN BSN IBCLC RLC


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