Plastic and Craniofacial Surgery
Perhaps the most immediate and frustrating concern for the mothers of infants with cleft lip and palate are related to feeding shortly after the birth of their baby. This is particularly so when breastfeeding is attempted. The speech therapists are the most valuable members of the cleft and craniofacial team during this time. They play an important and evolving role in your child’s cleft care. This is especially true in preparing for the first days after your baby is born and helping to follow their progress with feeding, since babies with cleft lip and palate and isolate cleft palate have special feeding needs.
Babies born with cleft palates are unable to drink milk directly from their mother’s breast or an ordinary baby bottle and nipple. This is because there is an opening in the roof of the mouth (palate) that prevents the baby from creating suction to form a correct seal around the breast or bottle nipple to pull the milk out for drinking. Therefore, the baby needs to use a specialized bottle/nipple that does not require suction to deliver milk and formula. These bottle/nipples include the pigeon nipple, Medela Special Needs Feeder and Cleft Palate Nurser.
Ideally, we have met you before the birth of your child and have been able to provide you with feeding supplies and education materials that will make the first days with your baby easier with regard to feeding. It is important to note that the average baby with cleft palate does not have a problem with swallowing or weight gain when the appropriate feeder is used.
If you did not know that your baby would be born with a cleft or you were unable to meet us before the delivery of your baby, you should be evaluated by members of an American Cleft Palate-Craniofacial Association-certified cleft team, such as our team at Children’s Health℠, within one week of being discharged from his/her birth hospital.
The speech therapist will look in your baby’s mouth to check the size and location of the cleft, as well as feel the muscle tone of your baby’s face, tongue and lips and check for age-appropriate feeding responses. Then, the speech therapist will watch your baby feed with the nipple/bottle you bring to the appointment.
We are looking to see how easy or hard your child is working to eat. We also look for signs that tell us the milk may be going down toward the lungs instead of the stomach. These signs include red, watery eyes; cough; choking; throat congestion; skin color changes; and fast breathing. The speech therapist may change your baby’s bottle/nipple based on the exam.
There are many benefits of breastfeeding, and we encourage our mothers to feed their babies breast milk. Because cleft palate prevents latching, however, attempts to breastfeed often become a source of frustration and worry for mothers of a baby with cleft palate. We advocate breast pumping and using the breast milk in the specialized feeder that the speech therapist provides you. This allows for the most efficient feeding of breast milk and the best chance of weight gain for your baby.
Feeding your baby should last 30 minutes or less so your baby can gain weight easily. You will be asked how long it takes to feed your baby, how much milk your baby takes each time he/she feeds and how often your baby eats. This helps us to know if your baby is getting enough to eat each time, or if we need to make changes to the bottle/nipple or refer you to a dietitian to help with your baby’s weight gain. Once we complete our assessment of your baby’s feeding and determine the best nipple/bottle system, we will provide you with additional nipple/bottles as they are not available to buy in stores.
Children born with cleft lip and palate often undergo treatment by an orthodontist and have a nasoalveolar molding (NAM) appliance placed in his/her mouth. This appliance is helpful in preparing your child for cleft lip repair. It is important for the speech therapist to watch your baby eat after this appliance has been placed in his/her mouth. We want to be sure your baby continues to eat well with the appliance, even if that means we have to change the nipple/bottle system. Usually the NAM appliance will not affect feeding and may even improve it.
After the cleft lip and palate have been repaired, the speech therapist will continue to ask about how your child is feeding. It’s important for your child to progress to solid foods, including baby foods and spaghetti, and regular foods, such as meats and breads. Equally important is moving your child from drinking from the special nipple/bottle to a sippy cup, regular cup then straw drinking. If your child has difficulty with feeding at any time, the speech therapist may recommend feeding therapy or additional testing, such as a swallow test, to help you and your child find the best and safest way for your child to eat by mouth.