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Children's Hospital at Dartmouth Hitchcock (CHad)
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Feeding Recommendations

For infants with cleft lip only

Infants with isolated cleft lip (that is, without a cleft palate) can usually feed from either the breast or via a standard bottle without any modification. It is the action of the jaw and the tongue against the palate (the roof of the mouth) that supports feeding. The lips play less of a role in breast and bottle feeding than one would assume. Dribbling from the cleft in the lip can be observed during feeding, but should not interfere significantly with your baby’s ability to feed effectively.

For infants with cleft palate (with or without a cleft lip)

Infants with a cleft palate are at a distinct disadvantage for breast and bottle feeding. These children are unable to generate adequate suction to keep a breast nipple compressed in the mouth for feeding and/or have difficulty drawing liquid out of a standard bottle.

It is unlikely that you will be successful breastfeeding your newborn with a cleft palate, depending upon the size of your child’s cleft. Making an attempt is certainly reasonable and important, if this is something that you had hoped to do. Please keep in mind, however, that babies with large clefts will have difficulty keeping the breast nipple in their mouths. Of course, your baby can still be fed pumped breast milk instead of formula, if that is your desire. Modifications in breastfeeding can be approached with the help of a lactation consultant and/ or a feeding specialist.

Specialized cleft feeding bottles

In order to feed babies born with clefts who are unable to breastfeed, we recommend one of two specialized bottles. Although many bottles are designed for cleft palate, we have found these two bottles to be particularly helpful.

  • The SpecialNeeds Feeder is made by Medela. There are two types of Haberman bottles and we typically use the standard over the "Mini-Haberman" ("Mini" refers to the length of the overall nipple. The "Mini" bottles are more often used with small or premature babies). Although this bottle may look intimidating, many babies use it with great success. The bottle features three flow levels (off, medium, or fast), has a one-way valve, and lets you squeeze the bottle’s nipple to help your baby along if needed. These bottles come with a nipple and a bottle portion, a ring that the nipple sits in, and a two-piece valve. The nipple, valve, and ring can be used with standard bottles as well. You can order online or at (800) 435-8316.
  • The Pigeon Feeder is made by Children's Medical Ventures. This bottle has a bottle portion, a nipple, a ring, and a valve. This nipple works best on the bottle that it comes with and tends to get compressed when used on standard bottles. The nipple has a notch that lines up with a harder portion of the nipple at the tip. This is placed in the baby’s mouth with the notch lined up with the baby’s nose. The hardened portion of the nipple acts as a surrogate palate. This is a relatively fast flow nipple and, as above, the valve portion is critical to its function. To order, go online or call (888) 766-8443.

Both of these bottles let a baby be active in the feeding process. Other systems, including the Mead-Johnson bottle, the Ross Cleft Palate Nipple, and the Acepto syringe, are controlled by the feeder and not by the baby. They work by squeezing a bottle or a syringe and directing the flow of milk into the side of the mouth. Your surgeon can help you determine which bottle will be best for your baby after cleft repair.

Feeding issues

Nasal regurgitation: Babies without a fully formed palate can sometimes leak liquids from their noses as they eat. Nasal regurgitation can pose problems over time and create nasal and sinus congestion.

Ask your pediatrician or feeding specialist about saline nasal spray, such as the Ocean brand, or bulb suctioning to clear the nasal airway after meals if your baby has chronic congestion. Xlear, a Xylitol-based nasal wash, is also available.

If your baby does have a tendency towards nasal regurgitation, try a more upright position while feeding.

Burping: Babies with cleft palate need to be burped often. Burping frequently during a feeding will make your baby more comfortable and may help to reduce spitting up. If spitting up is excessive, contact your pediatrician or feeding specialist.

Feeding times should not be in excess of 20-30 minutes. Longer feedings are more work for the baby and more stress for parents and families. It is important that feedings be positive for all involved, and modifying the bottle or delivery system can help. If you are struggling to feed your infant within this time frame, contact your pediatrician and/or your feeding specialist.

Goals of successful feeding

  • Make sure your baby has the best nutrition possible.
  • Make sure feeding is not too much "work."
  • Make sure your baby gains weight and thrives.

Problems to watch out for

The following signs might indicate that your baby is having trouble with feeding.

  • Gagging/choking
  • Excessive nasal regurgitation or drooling out of the mouth
  • Heavy or fast breathing
  • Excessive sleepiness
  • Excessive spitting up, accompanied by arching of the back, crying and discomfort
  • Grimacing or flaring of the nostrils
  • Tongue movement past the lower lip during feeding, or tongue movement that is curled back and upward in the mouth.

Remember that every baby is different. If you have problems with feeding, you are not alone. Help is available if you ask for it.

Compiled by Cheryl M. Lundgren, MS CCC-SLP in collaboration with Virginia McGoey, M.Ed., CCC-SLP. References used include Lisa Young, MA, CCC-SLP, Catherine Shaker, MS CCC-SLP and Joan Arvedson, PhD.

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