Special feeding needs of a baby born with a cleft of the palate

Feeding the newborn baby

Giving birth is an extraordinary emotional experience. Feeding the newborn is a vital and the primary concern of every mother. Feeding is much more than giving food. Feeding is a moment of sharing, of mutual discovery. Extremely strong ties are created between mother and child. Feeding a baby should be a rewarding and enjoyable experience for both mother and child.

Feeding a baby born with a cleft of the palate requires some adaptation and special needs may require special solutions. The presence of a cleft of the palate makes it difficult for the newborn to exert sufficient negative pressure on the bottle’s nipple to get the milk flowing without excessive effort.

 

What is the impact of a cleft on bottle feeding ?

Feeding difficulties differ with the type of cleft

  • Cleft of the lip 

With this type of cleft, only the baby’s lip is affected. There is no change in the inside of his mouth and the suction mechanism is not altered. It can therefore be bottle- or breast-fed normally. The breast nipple is flexible, it takes the shape of the baby’s lip. As the muscles of his lip are separated, it is possible that at the beginning, the child will have difficulty taking the breast or the bottle’s nipple. Every baby needs time to learn how to suck. The choice of the feeding mode of your baby therefore belongs to you according to your values ​​and your desires.

  • Cleft of the lip and alveolus 

With a cleft of the alveolus, the dental arch is affected. A wide opening of the dental arch may require a special positioning of the baby to help him take the breast. A midwife or nurse on the team can advise you.

  • Cleft of the palate

Your baby should be eating in about 30 minutes or less. Longer meals are tiring him too much. Efforts to eat take too much energy and reduce the benefit. A baby with a cleft of the palate has an opening in the palate. This prevents it from creating negative pressure needed to draw milk from the breast or bottle. The newborn with a cleft has normal suction and normal swallowing reflexes, but because of the difficulty or inability to create negative pressure in the oral cavity, some adaptation will be needed.

It is also possible that during feeding, milk comes out through the nose. The baby can also swallow too much air. The baby should get enough milk in a reasonable amount of time and avoid swallowing too much air. Here are a few tips :

  • Place the baby in a semi-sitting position, with the back straight to avoid regurgitation through the nose
  • The baby’s head should be well aligned with the body and not tipped back or turned on the side
  • Be careful that the bottle nipple is full and facing down so that the baby does not swallow air.
  • A baby with a cleft needs more breaks during the feeding to burp because it takes more air while eating
  • If milk comes out the nose, it can make him cough. Which is good because it’s clearing his nose.

What about breast feeding ?

Except in rare cases, complete breastfeeding is not possible in the presence of a cleft of the palate. The opening in the baby’s palate does not allow him to take the breast by creating negative pressure and making sucking effective. The baby gets tired, and he can not gain weight that way. Hearing that breastfeeding is not possible can be a source of disappointment and sadness for most mothers. Give yourself time to accept this situation. The psychologist on our team can help you in this process. If you wish, you can still share with your child some benefits of breastfeeding:

  • You can collect your milk with a breast pump and feed your child with a bottle
  • During bottle-feeding, experience visual and physical contact with your child  as much as possible
  • Once the baby has been able to eat efficiently, he can enjoy breast-contact for a moment of mother-baby sharing, havoing received sufficient milk from the bottle.

After surgery and once the postoperative period is over, you can try again to breast-feed your child. To be successful, it is essential to have pumped your milk from birth and throughout the period until the operation to stimulate lactation. Be aware, however, that babies are getting used to the bottle and the additional effort they must provide to breast-feed may be unproductive.

Psychological issues

Pregnancy and the first years of life are a dynamic and sensitive period. As a parent, everyone wants to transmit the best to their child for a harmonious and healthy development. Feeding can be considered as a privileged experience in which some of these phenomena of transmission are played out. Food represents an axis around which ties will be created.

Being confronted with dietary difficulties with a child during this period can bring out an intense emotional burden to parents. Despite the efforts made, support can sometimes be an alternative to ease and control feelings of worry and helplessness that some parents may suffer from. Professional help is available to discuss about the child’s development regarding for example: the positioning of the child, the stimulations at the level of the oral zone, the temporal dimension in order to favour cycles of interaction parent-baby.

It can also mean support by a psychologist. It is important to pay particular attention to the sphere of nutrition, since it affects the emotional, sensory and functional levels of relationship.

authors:

Dr. Georges Herzog, orthodontist; Prof. J. Hohlfeld, pediatric surgeon; J. Despars, psychologist

 

Adresses utiles

Dr. Anthony De Buys-Roessingh, pediatric surgeon, director of the CLP team CHUV Lausanne

+41 21 314 30 62

Psychologist: J. Despars +41 21 314 35 35

Nurses: Christelle Jung, Louise Fleury Joèlle Foglia Tel. : +41 79 556 49 61

dmcp.flmp@chuv.ch

Pediatric nurses : http://www.espace-prevention.ch

Orthodontists: Drs. Georges Herzog & Laurent Medinger: +41 21 728 02 25