Dear Denise P. I have been following your case of the baby with a bubble palate and slow weight gain very closely. I didn't respond immediately since I am so far behind on reading lactnet. I would like to continue to hear follow up on this case and wanted to share a reference that I found on bubble palates. I am wondering why there has not been more discussion of the bubble palate as a cause of the baby's poor suck and resulting poor milk transfer. I have zilch personal experience with bubble palates, so I tried looking it up in all of my main references. To my surprise it is only listed in one (see next paragraph), though high palate is referred to in the LC series on Inadequate weight gain. Your comments indicate that you are aware that a bubble palate is possibly a cause for sore nipples, but I can't tell if you are linking the baby's inability to maintain strong suction to this also. Your use of the p-syringe rather than a suction based supplementer causes me to suspect you do. Yet, I would have expected more focus on this possibility rather than on mother's ability to produce milk in light of how mother's supply and baby's weight gain has responded appropriately to your intervention. Here is what I found in Chele Marmet, MA IBCLC & Ellen Shell, MA IBCLC, Lactation Forms: A Guide to Lactation Consultant Charting (Encino, CA: Lactation Institute, Publishers, 1993 for chapter in reference) chapter 4, page 7. "Concave bubble: A concavity in the hard palate, usually about 3/8" to 3/4"(1 to 2 cm) in diameter and 1/4" (1/2 cm) deep. Because the bubble may not fill up with compressed breast tissue during breastfeeding, the lack of vacuum may be somewhat similar to those of a baby with a cleft palate......." Does this sound like what could be going on? Is the mother's breast small and inelastic making it harder for the breast to fill in the cavity? I wonder if this will affect this baby's bottle-feeding ability? Hope this helps. I will be on lactnet nomail from Dec 23-27, so I will not be able to respond immediately to any comments you may have on this. I will be getting the back log for those dates when I return (I can't stand to miss any :-)) so go ahead and keep writing to all of us here. Natalie Shenk, BS IBCLC; Private Practice LC in Findlay, OH, USA who loves when other LCs share the details of their difficult cases! THANKS Denise!