This could be caused by an overt cleft, a submucous cleft of the soft
palate, or velopharyngeal insufficiency (VPI), a dysfunction of the soft
palate.  It's important to know which it is, because there are different
things that can be done for each condition.

If it is VPI, helping the baby increase bolus control for swallowing by
working to improve tongue grooving might be helpful.  Mom might need a
lot of support, because the fussiness and pulling off can escalate into
feeding refusal due to the baby's discomfort.  I've seen several babies
with this condition this year.  The one who was the most difficult to
feed is now turning a year and is easier now.  One of the hallmarks of
VPI is harsh respiration during feeding with increased effort of feeding
and without cyanosis.  Short sucking bursts are also common, and long
respiratory pauses.

If the baby has a submucous cleft, there might be VPI because of it.
Even an occult submucous cleft (without a bifid uvula) can cause low
milk intake.

In the case of the baby you mention, slowing down mom's flow is probably
the most important first step.  If there is a case of VPI and/or
clefting , the baby is probably going to have more trouble with flow
than a baby without these conditions.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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