Parents

Feeding Advice

A cleft in the palate means that your baby may have difficulty in sucking effectively as he or she is unable to create a good vacuum inside the mouth, and correctly position the tongue. Babies born with a cleft palate only, may be more difficult to feed than those born with a cleft lip or cleft lip and palate. Very occasionally it may be necessary to use a combination of naso gastric tube feeding and teat/breast feeding. During the first two months following birth.

What about plates?

Not all teams are agreed on the benefits of using feeding and orthopaedic plates from birth so do ask if and why a plate is considered necessary for your baby.
Some teams use a small feeding plate for the baby to wear in the roof of the mouth. This may be made by your orthodontist to:

  • assist with breast feeding
  • protect the delicate tissue in the roof of the mouth
  • keep baby's tongue out of the cleft

A special orthopaedic plate may be used to begin to apply pressure to close and align the cleft prior to surgery. Plates ( obdurators ) need to be checked and adjusted or renewed at intervals so the orthodontist will want to see your baby regularly.

What if milk escapes from the nose?

If the flow is too fast, milk may pass into the nose and cause sneezing, or some milk may come down the nose if your baby is being sick. Your baby will normally clear this but have some tissues or a bib handy!

What about oral hygiene?

Babies do not produce much saliva during the first 2 months of life. Formula fed babies may require 2 to 3 teaspoons of cooled boiled water after a feed to ensure that any milk is removed from the nasal airways. Formula milk left in the airways may result in a snuffly baby. This is not necessary for babies fed on breast milk as breastmilk leaves no deposits in those areas.

What about breastfeeding?

Breastfeeding a baby with a cleft palate works well when the cleft is small or narrow. The breast needs to be held well into the area where the palate is intact so that the baby can get a good grip and work at the breast with the tongue. A baby born with a cleft palate will need help in achieving a good "latch on". A specialist nurse will be able to help you with this.

If your baby is allowed to practice on the soft breasts in the early days, it will be easier for you to find a position that is comfortable for both of you and baby will benefit from the valuable colostrum. At about 2 - 4 days after delivery when the breasts fill it will be natural for him or her to have more difficulty in breastfeeding.

It is helpful to have a good flow of milk, as your baby may not have a strong enough suck to stimulate the flow. The flow of milk can be encouraged by massaging the breast or by using a breast pump. Your midwife will be able to show you how to massage your breast and hand express the milk when a breast pump is not available.

The breasts need to be expressed after feeding to ensure that they receive adequate stimulation. The baby satisfies his thirst on first suckling and his hunger on the hind milk which contains more calories. Your baby may need to be supplemented using expressed breastmilk with an alternative feeding method as his suckling may not give him sufficient volumes of milk to ensure adequate growth.

If your baby is unable to suckle at the breast prior to having the palate repaired it is possible with commitment for him to taste and lick milk expressed onto the nipple and be fed with expressed breast milk by another feeding method. Many parents feel very satisfied having done this.

There are several alternative cup and spoon type methods, cup feeding, and a supplemental nursing system. Breast pumps can be hired and the baby given mothers milk. Do talk to your midwife, cleft team feeding advisor or CLAPA parent contact supporter about this.
Take it a week at a time and review the situation, deciding whether to continue for another week.
Breast milk does not irritate the delicate tissue in the nose and throat as much as formula milk and can help to reduce the risk of ear problems developing.
There are some booklets written specifically for mothers who wish to breastfeed their baby with a cleft

What about bottle feeding?

Many babies will need extra help to enable them to take sufficient nourishment in a reasonable time, say 30-40 minutes.
You need a teat on which your baby can grip well and a good flow of milk. This can be achieved with an ordinary bottle, though the hole or holes in the teat may need to be enlarged or extra ones made.

If your baby is feeding slowly, it may be necessary to experiment with different teats as some manage better with one such as an orthodontic shaped teat. If using an orthodontic shaped teat the hole is best made on the non-cleft side and slightly towards the tongue so that milk is aimed downwards and away from the cleft.
Others need a soft bottle which can be squeezed as the baby sucks to help the flow of milk . This may give you more control than an enlarged hole. Nursing your baby in the usual cradling position is possible in most cases. Babies born with a cleft palate alone may be nursed and fed on their sides
Some babies may not have the energy to suck from a teat, and here a cup and spoon method may be helpful. Feeding from a scoop attached to a soft bottle (e.g a Softplas bottle and scoop) requires less effort from the baby.

What about feeding after the palate operation?

The timing of the palate operation may vary from hospital to hospital, depending on the type of cleft and operation that your surgeon performs. This may mean that your baby is weaned , but still using a bottle for milk or other liquids.
In some areas the surgeon prefers you not to use a bottle immediately after the palate operation so ask your team for advice, as you may need to get your baby used to a spoon bottle or short spouted trainer cup before the operation. The same may apply to a dummy