Feeding an infant with cleft lip and palate
A baby with a cleft lip and/or palate will have some special needs with feeding. You will learn together how best to feed your baby.
Cleft Lip (No Cleft Palate)
If the infant has only a cleft lip, there should be no loss of suction and the infant can suck well from either bottle or breast. When the gum and lip are cleft, the infant’s suction may be reduced and the baby might need a bottle with a freer flow rate, such as one of the vented bottles on the market, or a juice nipple. Some parents find that pushing the two sides of the lip together without blocking the nostrils restores suction immediately. The following are suggestions to help you decide how best to feed your baby.
Breastfeeding an infant with a cleft lip but no cleft palate will be successful, but sometimes requires a changed feeding position so that mother’s breast tissue fills the gap in the lip or gum. A Lactation Consultant should be your best resource in finding the best way to breastfeed your baby with cleft lip.
The most immediate concern for a baby with cleft palate is good nutrition. Having a cleft palate prevents an infant from making enough suction in the nipple to draw out milk from the breast, or formula from a regular infant feeding bottle. That is because there is a hole 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 that has a hole in it. If you work very hard, you may be able to suck in a small amount, but not enough to provide nourishment. Your newborn needs to minimize the work needed for feeding, otherwise they will lose too much weight and not gain weight in a healthy manner (because they’re expending too many calories trying to feed).
For this reason, we do not advise breastfeeding an infant with cleft palate to 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 anatomy, 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 cleft palate include the Haberman Feeder, the Enfamil Cleft Palate Nurse by Mead Johnson, and the Pigeon. Each of these feeding systems works 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 practice putting them together and seeing how they work.
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 and plenty of helpful tips. You may also order written materials and specialty bottles through their website.
When you feed your baby with 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 hole between the nose and the mouth. Your child has automatic reactions that protect his airway just like anyone else, 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 it. If there is a great amount of liquid in the nose, or if your baby spits up, tilt the baby forward. Your baby will swallow any extra milk in the back of the throat and the extra milk in the front of the mouth and nose will drain out by gravity. You may use a bulb suction to help, but the positioning is important to prevent any extra liquid from sliding to the back 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 the 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 he’s doing 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 make sure he doesn’t lose too much weight, and begins gaining appropriately. (Make sure your baby is weighed naked (no diaper) for the first few weeks to ensure accuracy.) Ideally, your child will return to their birth weight by age 2 weeks, and gain weight normally thereafter. Some babies take a little longer to regain their birth weight.
At UNC Hospitals, 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, flow rate, and other aspects. 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 the Plastic Surgeon.