Excerpt from 'Feeding an Infant with a Cleft'
To download the PDF version of this factsheet, click here
Feeding Problems Associated with Cleft Palate
An infant with a cleft of the lip only or of the lip and gum ridge does not typically experience feeding problems. Like all newborns, learning how to “latch on” at the beginning of a feeding will quickly become second nature to him or her. However, an infant whose cleft involves the palate will require some modifications in feeding technique, supplies, and positioning, because he or she lacks the usual separation between the nasal cavity and the mouth. These children often have a weak sucking ability and may experience problems such as nasal regurgitation, long feeding times, and difficulty coordinating swallowing and breathing. A baby with a cleft palate must squeeze the milk out of the nipple by compressing it between the tongue and whatever portion of the palate exists. He or she may swallow a lot of air while feeding, necessitating frequent burping. Most problems of this type can be managed with adapted techniques.
Feeding an Infant with a Cleft Palate
Regardless of what feeding system you choose for your baby, most health care providers agree that breast milk is the best food for newborns. (The American Academy of Pediatrics recommends breast milk for children up to one year of age.) If using breast milk is not an option, your health care provider will help you select the most appropriate formula for your baby based on nutritional composition and compatibility with his or her digestive system. If the formula is to be mixed or diluted, read the directions on the product label carefully to assure correct measurement.
There are several different bottles and nipples on the market that have been specifically designed for children born with clefts. When choosing feeding supplies, you may want to look for the following features:
- a soft, thin-walled nipple that compresses easily;
- a nipple that allows the milk to flow at a moderate pace, neither too fast nor too slow;
- and a method that does not interfere with the normal swallowing mechanism or the normal activity of the oral-facial muscles.
Many parents also want bottles that look “normal” and are easily and inexpensively obtained.
Regardless of what combination of nipple and bottle you choose, the goal is to make feeding easy for your baby while still allowing him or her ample opportunity to suck. For this reason, a soft nipple is generally better than a hard one. Because “preemie” nipples are soft, they are often the first ones to be tried when more specialized supplies are unavailable. As your infant grows and gains strength, he or she may graduate to a different type of nipple, particularly if the nipple is collapsing during feeding.
Some infants with clefts have trouble feeding from nipples that are either too short or too long. Short nipples do not make sufficient contact with the palate and tongue, and long nipples may trigger the infant’s gag reflex. One nipple which is sometimes used for a child with a weak suck is the Ross nipple, which is soft and shaped like a tube to direct the milk flow past the cleft.
Many health care providers recommend bottles with cross-cut nipples, which control the flow of milk using the baby’s normal rhythm of sucking and swallowing. Cross-cut nipples have an X-shaped opening which allows the milk to flow only when the infant squeezes the nipple. Simply enlarging the hole in a nipple results in a constant flow of milk, loss of control when the baby tries to swallow, and increased difficulty in coordinating swallowing and breathing. Any nipple can be cross cut manually by using a single-edge razor blade.
Using a squeeze bottle or plastic bottle liner is another way of increasing the flow of milk and conserving your baby’s energy. When using a plastic bottle liner, push all the air out of the liner before beginning a feeding, then apply intermittent pressure to the liner as the baby squeezes the nipple. This method minimizes the amount of air the baby swallows and makes sucking easier. Squeeze bottles (also referred to as “assisted delivery systems”) for children born with cleft palate include the Mead Johnson Cleft Palate Nurser, the Haberman Feeder, and the Pigeon Bottle.
The Mead Johnson Cleft Palate Nurser has a soft, thin-walled nipple that is already cross cut. The long nipple is designed to direct the milk flow past the cleft. The bottle is soft and can easily be squeezed in rhythm with the infant’s suck and swallow. This technique overcomes the baby’s inability to create the vacuum needed to suck milk from the bottle. The bottle should be gently pulsed, not continually squeezed. Following the infant’s own rhythm helps to ensure that he or she does not inhale milk into the lungs, an occurrence called “aspiration.”
Mead Johnson Cleft Palate Nurser
Mead Johnson Nutritionals
Evansville, IN 47721
812.429.5000
800.222.9123
AskMeadJohnson@bms.com
http://www.meadjohnson.com
The Haberman Feeder has a large, squeezable nipple with a slit rather than a cross cut. Markings around the base of the soft, pliable nipple indicate the position of the slit relative to the infant’s mouth. The markings allow the person feeding the baby to control how quickly the milk flows. A disc located inside the base of the nipple acts as a one-way valve to allow milk into the nipple, while reducing the amount of air in the nipple that the baby can swallow. This nipple comes in two sizes—regular and “mini.” While the regular nipple is standard length, the mini nipple is shorter, equivalent to a preemie nipple.
Haberman Feeder
Medela
1101 Corporate Dr.
McHenry, IL 60051
815.363.1166
800.435.8316
http://www.medela.com/NewFiles/specialtyfdg.html#haberman
customer.service@medela.com
The Pigeon Bottle comes with a nipple that has a Y-cut (as opposed to an X cross-cut). The nipple is slightly larger and more bulbous than other types of nipples, fitting naturally into the oral cavity. It is firm on top and soft at the bottom to allow for easy tongue compression. An air valve prevents the nipple from collapsing while the baby is sucking. Tightening or loosening the collar on the bottle controls the speed of the flow of milk. The stopper, or back-flow valve, prevents the milk from flowing back into the bottle from the nipple and reduces the amount of air the infant swallows. Although the bottle is not soft, it is pliable.
Pigeon Cleft Palate Nurser
Distributed by Children’s Medical Ventures
South Weymouth, MA
800.345.6443 Hospital Orders
888.766.8443 Parent Orders
http://www.childmed.com/Product_Info/product.cfm?p=2CB0E508-3757-4B8A-88E934A055213CB3
No matter what nipple or feeding system you use, feeding is often easier if the nipple is angled to the side of the mouth so that milk is directed away from the cleft. In this way, the baby can squeeze the nipple between his or her tongue and upper gum. Your health care provider can help you choose the nipple or feeding system that will work best for you and your infant.
Last Updated: Oct 25, 2007