Introduction

Feeding is one of the early needs to be given due attention and care. Being able to achieve feeding will create many positive impacts and provides a sense of normalcy for the parents (esp mothers).

• Reduces anxiety of the parents

• Enhances bonding between mother and child

• Facilitates growth and development of child

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Feeding Challenge

A cleft child may not be able to feed normally due to challenges related to inadequate suction caused by the absence of a good seal when a cleft baby tries to latch to a nipple or teat. Additionally milk may aspirate out of the nostril as there is no separation between the oral and nasal cavity (for cleft palate).

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Mother’s Milk as Priority

Mother’s milk should be given priority as it is proven beneficial for babies. Breastfeeding is also recommended (especially for babies with a cleft lip where breastfeeding has been successfully achieved). For more information, please visit http://www.bfmed.org/Resources/protocols.aspx (Item no 17). Babies with cleft palate may face more challenges in which case, assisted feeding via bottles and teats can be used as alternative. In any event, mothers are encouraged to attempt breastfeeding and use bottles, spoon et cetera only after breastfeeding cannot be achieved. Breast milk can be expressed and use in such feeding aids.

 

 

Feeding Aids

Feeding aids which can be considered and are available in the market include the following:

• Soft bottle – bottle is squeezed (Softplas from CLAPAM, Pigeon, MAM dsb)

• Bottle with squeezable teat (Medela-Haberman)

• Bottle with spoon (SoftPlas, Pigeon, Medela)

• Soft teat (latex such as NUK)

• Nasogastric/Feeding Tube

• Syringe, Spoon, Cup (without need for bottle)

 

 

Feeding of Cleft Babies

Length of time: Cleft babies tend to suck slower so the feeding time may take longer. If your baby gets tired, give smaller amount of milk but at frequent intervals. Do not be discouraged but continue to let the baby suckle as the suckingmotion will help develop the muscles in the mouth for feeding, chewing, and later for speech development.

 

Milk coming through the nose: Do not be overly worried if some of the milk comes out through the nose of a cleft-palate baby, causing some spluttering or coughing. This is normal because of the presence of the hole in the palate. You must therefore be gentle and patient when feeding the baby. Do not rush a feed as this might choke the baby.

 

Refusal to feed: If the baby refuses to feed, try to relax and be patient with the baby. Cuddle or hold the baby for a short while before returning to feeding. If the opening of the teat is too small, you can make the hole bigger by sticking the end of a red-hot needle into the hole. Remember to burp the baby more often as this minimizes stomach discomfort.

 

Pre-Surgery: Ideally, it is advisable to introduce a bottle with a spoon feeder a few weeks before a surgery. This will enhance the success of the surgery because bottle teats may injure the sutur line (line of stitching) and potentially cause the repaired cleft to split open when the baby tries to suck on it. Moreover, a baby who is not used to spoon feeding may refuse such feeds during postsurgery period. This may irritate the baby and cause excessive crying which again may cause the

repaired cleft wound to split

 

Avoid choking and liquid build up in the ear: When feeding your baby, whether by spoon or bottle, always keep the baby in an upright position in the feeder’s lap, with the head and back well supported. This is to avoid choking. Specific to cleft-palate babies, feeding in an upright position reduces the chances of milk escaping from the nose. More importantly, it helps prevent the chances of milk from going into the middle ear which may cause ear infection due to fluid buildup.

 

Post-Surgery: After a surgery, feed the baby using the bottle with a spoon feeder. Gently squeeze the soft bottle to bring the milk out and put the feeder at the corner of the mouth or the edge of the lip to make swallowing easier for the baby. Spoon feeding is slower but do use this method at least until the repaired lip/palate heals. When the lip and palate repairs are done and healed, feeding the baby would be a lot easier. After a post palate surgery, liquid diet is advisable. Parents have reported that soft ice cream, yoghurt and fruit puree are good. Soft ice cream has the cooling and soothing effect, and helps with the blood clotting.

 

Solid Food: A cleft baby should be introduced to solid food just as any other baby. However, a lot of patience and care is needed to monitor the food intake. For example, the solid food can be diluted to cater to the baby’s needs. Do not be alarmed if food comes out of the nose in a cleft palate baby. The baby will learn to adapt.