Neonatal Cleft Lip and Palate Protocol:
Instructions for Newborn Nurseries

Reassure parents that the baby’s cleft is not their fault and was not caused by anything they did.

Reassure parents that cleft lip and palate is correctable with surgery, and introduce the concept of a cleft palate/craniofacial team. A team is a group of health care professionals (surgeons, dentists, speech pathologists, nurses, mental health specialists, and others) who work together to treat a child with a facial birth defect. If you don’t know of a team in your area, call the Cleft Palate Foundation at 1.800.24.CLEFT.

Review feeding instructions and refer to CPF’s Feeding Video. To have feeding information, including CPF’s interactive CD-ROM sent to you, call or email the Cleft Palate Foundation. Newborns with cleft lip only should be able to feed normally using standard techniques. Newborns with cleft palate may benefit from the information below.

Assess feeding to be sure that the child can feed adequately using the following guidelines:

• Make sure the child is feeding in an upright position. Gravity will help prevent milk from coming through the baby’s nose if he/she has cleft palate.
• Mothers interested in breastfeeding should initiate breast pumping. Direct breast feeding is extremely challenging for a child with cleft palate.
• Use a cleft palate nurser or other squeezable bottle with a larger x-cut hole in the nipple. The hole in an orthodontic nipple can be turned into a “x” shaped opening using a razor blade if a specialized bottle is not immediately available.
• Mom should take her time, and burp the baby frequently. Infants with cleft palate tend to swallow a lot of air during feedings.
• Eventually, feeding time should be no more than 30 minutes for 2-3 ounces.
• If the child is still having difficulty feeding, consult a feeding specialist with a cleft palate/craniofacial team. The team’s nurse, speech-language pathologist, or social worker may provide this support.

Consult with a hospital social worker to provide the family with emotional support and community referrals.

Contact the pediatrician or family doctor. Ask a physician where to refer for cleft palate/craniofacial team care, and make this referral before the child is discharged from the nursery.

Consult with a public health nurse if the child shows signs of feeding difficulty. Make sure that a either the public health nurse or the team’s nurse will follow up with the family promptly.

Follow up with the family after discharge with a phone call to make sure there are not any new problems not being handled by the cleft palate/craniofacial team.

Bottles and other products manufactured for infants with cleft palate:

Please refer to CPF’s Feeding Video for information on how to use these bottles.

Enfamil Cleft Palate Nurser by Mead-Johnson
Phone: 800.222.9123
Email: AskMeadJohnson@bms.com

Haberman Special Needs Bottle by Madela
Phone: 800.435.8316
Email: customer.service@medela.com

Pigeon Bottle by Respironics
Phone: 888.766.8443 (Parent Orders); 800.345.6443 (Hospital Orders)

Ross Cleft Palate Nipple
Phone: 1.614.624.4683