Carole Falletta
Co-Founder at - Momentum Health NetworkCarole Falletta, MS, MA, PMHNP-BC, FNP-BC, RNC-EFM, IBCLC, LCCE Carole is a nurse practitioner with over 30 years of experience in nursing, specializing in women's health, newborn care, and reproductive and postpartum mental health. Actively practicing in healthcare, she supports women and families during the perinatal journey through compassionate, evidence-based care. A dual board-certified nurse practitioner in psychiatric and family health, Carole is also an International Board-Certified Lactation Consultant (IBCLC) and Lamaze Certified Childbirth Educator, combining her clinical expertise and passion for education to empower mothers and support babies.
Sometimes, despite everyone’s best efforts, a baby just won’t latch—and as a maternal health educator and lactation consultant, I’ve learned to listen closely when something doesn’t add up.
Let me share a story.
A few months ago, I was supporting a mother whose baby had been trying to latch for nearly 48 hours with no success. Everyone had looked in the baby’s mouth. The pediatricians reassured her that the palate was intact. But still, no latch. I remember standing there watching this baby try, over and over, rooting and searching, but unable to maintain suction. Something didn’t feel right.
I gently explored the baby’s mouth and felt a high, narrow palate—and with a closer look, I saw it: a submucosal cleft palate. Hidden behind the intact mucosal covering was a gap in the muscles of the palate, preventing the baby from creating the suction needed for breastfeeding.
What Is a Submucosal Cleft Palate?
This kind of cleft can significantly affect feeding, as babies cannot generate the negative pressure required to suck. It’s different from a cleft lip, which is often visible and diagnosed during pregnancy. Subtle clefts often require experienced hands—and sometimes imaging or a referral—to confirm.
Why It’s Important to Trust Your Instincts
This experience reminded me how important it is to trust what you see—and to advocate for further evaluation when nursing doesn’t go as expected. Not every baby who struggles to latch has a cleft, of course. But if a baby is persistently unable to latch or stay on the breast, and especially if there are signs like a high arch in the palate, frequent slipping off, poor weight gain, or nasal regurgitation, a cleft should be ruled out.
Can You Still Breastfeed?
Yes—and no. Many babies with cleft palates cannot nurse directly at the breast because they can’t maintain suction. But that doesn’t mean breastfeeding is off the table. Many mothers express breast milk and feed it through alternative methods while preserving the breastfeeding relationship through skin-to-skin and non-nutritive suckling when appropriate.
A feeding evaluation—often with a lactation consultant and a craniofacial team—is crucial to come up with a plan that supports both baby’s growth and the mother’s goals.
Feeding Tools That Can Help
When a baby with a cleft palate struggles to latch or maintain suction, specialized feeding tools can make all the difference. These include:
- Specialty bottles like the Dr. Brown’s Specialty Feeding System, Medela Special Needs Feeder, or the Haberman bottle, which help deliver milk with controlled flow and minimal effort from the baby.
- Pigeon nipples and cleft palate nipples designed for oral differences.
- Syringe or spoon feeding when neither nursing nor bottle feeding is possible.
- Supplemental Nursing Systems (SNS) at the breast to encourage stimulation and bonding.
Your care team will help select what’s best for your baby’s unique needs.
What Families Need to Hear
What made the biggest difference in this family’s story was that we paused, noticed what wasn’t working, and asked more questions.
Many families feel a sense of grief or confusion when something unexpected like this arises. It’s important to know that you did nothing wrong—and you are not alone. These situations aren’t always visible during pregnancy, and even the best-trained professionals can miss subtle signs in the whirlwind of postpartum care.
Getting support early—medical, emotional, and practical—can make all the difference.
Final Thoughts
As a provider who walks with families through the pregnancy, birth, and postpartum journey, I’ve learned that not everything shows up on a scan or exam. Sometimes the signs are in the way a baby feeds—or doesn’t.
When something feels off, pause and listen—because that moment might be the clue to getting the help your baby needs.
Breastfeeding may look different than you expected, but it’s still possible. And more importantly, you are doing exactly what your baby needs by showing up, asking questions, and seeking help.
Carole Falletta, MS, MA, PMHNP-BC, FNP-BC, RNC-EFM, IBCLC, LCCE Carole is a nurse practitioner with over 30 years of experience in nursing, specializing in women's health, newborn care, and reproductive and postpartum mental health. Actively practicing in healthcare, she supports women and families during the perinatal journey through compassionate, evidence-based care. A dual board-certified nurse practitioner in psychiatric and family health, Carole is also an International Board-Certified Lactation Consultant (IBCLC) and Lamaze Certified Childbirth Educator, combining her clinical expertise and passion for education to empower mothers and support babies.
