A baby with a cleft lip and/or palate will have some special needs with feeding. As parents, you will learn together how best to feed your baby.
Cleft Lip Only (No Cleft Palate)
If the infant has only a cleft lip, there should be no loss of suction and the infant should be able to suck well from a bottle or a breast. When the gum and lip are cleft, the infant's suction may be reduced and the baby may need a bottle with a freer flow rate, such as one of the vented bottles on the market (for example, Doctor Brown's Natural Flow or Playtex Ventair), or a juice nipple. Some parents find that pushing the two sides of the lip together without blocking the nostrils restores suction immediately.
Breastfeeding an infant with a cleft lip but no cleft palate will be successful, but sometimes requires a changed feeding position so that the mother's breast tissue fills the gap in the lip or the gum. A Lactation Consultant should be a good resource in finding the best way to breastfeed your baby with cleft lip only.
The most immediate concern for a baby with cleft palate is good nutrition. Having a cleft palate prevents an infant from creating enough suction in the nipple to draw out milk from the breast, or formula from a regular infant feeding bottle. This is because there is an opening between your child's nose and mouth that allows air to escape, preventing your baby from making a tight seal when suckling. To illustrate this point, picture trying to suck milk through a straw with a hole in it. If you work very hard, you may be able to suck in small amount, but not enough to provide nourishment. Your newborn needs to minimize the work needed for feeding; otherwise, he will not gain weight as he needs to (because he's using too many calories trying to feed).
For this reason, we do not advise breastfeeding an infant with cleft palate because this cannot provide for his nutritional needs. You may choose to provide breast milk for your baby by pumping and safely storing breast milk to be fed with a special cleft palate bottle. Placing your baby to the breast will help stimulate your milk supply for pumping and facilitate mother-child bonding, but because of your child's cleft palate, suckling at the breast will not give your child sufficient nutrition for growth. Your baby will need to use a special bottle designed for infants with cleft palate.
The most commonly used bottles for infants with a cleft palate include the Haberman Feeder, the Enfamil Cleft Palate Nurser by Mead Johnson, and the Pigeon Bottle and Nipple. Each of these feeding systems work a little differently. You may need to try several kinds of bottles/nipples before you find the one that works best for your baby. Many parents who have received a prenatal cleft diagnosis find it helpful to obtain bottles before the baby is born so they can see how they work and practice putting them together and using them.
The Cleft Palate Foundation is a wonderful resource and provides clear instructions on feeding an infant with a cleft palate, along with videos to show you exactly what to do with plenty of helpful tips. You may also order written materials and specialty bottles through their website. Click here for more information from the Cleft Palate Foundation on feeding infants with cleft palate.
When you feed your baby with a cleft palate, do not be alarmed if and when you see some milk draining out of the nose. That is simply milk leaking through the opening between the nose and the mouth. Your child has automatic reactions, just like anyone else, that protect his airway, so he may cough but the drainage from the nose will not cause harm. Keep in mind your baby doesn't know this leakage is not typical to every baby. You and he will both learn ways to feed him that minimize the leaking (also called "nasal regurgitation"). If there is a great amount of liquid in the nose, or if your baby spits up, tilt him forward. He will swallow any extra milk in the back of his throat. The extra milk in the front of the mouth and nose will drain out by gravity. You may use bulb suction to help, but positioning your baby forward, with head down, is important to prevent any extra liquid from moving from the back to the front of the throat.
In general, hold your baby up in a semi-upright seated position, to limit the amount of liquid that enters the nasal passage, with his head and shoulders in one hand and the bottle in your other hand.
Try to limit your baby's feedings to no more than 30 minutes. Beyond that time, the amount of work it takes for him to feed is probably greater than the number of extra calories he'll take in. And you need a break, too! As he gets better at feeding, these times will decrease and the amount he eats will increase. Your baby needs to be weighed frequently at his pediatrician's office in the early weeks to ensure he doesn't lose too much weight, and that he begins gaining weight appropriately (make sure your baby is weighed naked-no diaper-for the first few weeks to ensure accuracy). Ideally, he will return to his birth weight within 2 weeks, and gain weight normally after this. Some babies take a little longer to regain their birth weight.
At UNC Children's Hospital, we have Feeding Therapists on staff who can arrange a feeding session with you and your baby to offer hands-on feeding instruction, including positioning, bottle usage, milk flow rate, and many other helpful hints. If there are problems, the therapist can help determine which feeding system may work better. Most families only need one session with the therapist, but ongoing feeding sessions may be offered if needed. For infants who need extra help, the Feeding Therapists are a great resource. Contact Rachel Heller, RN, Craniofacial Nurse, at (919) 843-1088 about arranging a feeding appointment at the time of your child's initial appointment with your Plastic Surgeon.
Please keep in mind that UNC Children's Hospital and the Feeding team are unable to provide a supply of bottles or nipples to families. For Medicaid patients, the Women, Infants and Children (WIC) Program, the Special Supplemental Nutrition Program established by the federal government and administered at the county level, may provide specialty cleft palate bottles and nipples with a physician's prescription. Click here for the North Carolina WIC Program website.
Please click here for information about your ordering specialty bottles for your infant by phone or online through the Cleft Palate Foundation.
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