Feeding a newborn baby is one of the first joys, or potential challenges, when welcoming a new bundle of joy into the family. For infants with cleft lip and/or palate, feeding is often a significant hurdle to overcome. This can cause stress, frustration, and anxiety for the family in the first days, and sometimes weeks, of life.
In order for an infant to be able to express liquid from the bottle, he or she must be able to 1) compress the nipple and 2) suck. Infants with a cleft palate may have difficulties with both compression and suction, and cannot draw the liquid out of the nipple and bottle. This is similar to what it may feel like to drink liquids using a straw with a large hole in it – it’s challenging and very inefficient.
Breastfeeding is typically too hard for infants with cleft palate do to efficiently, for the same reasons that standard bottle feeding is also a challenge. Even if the infant is able to latch on to the breast, drawing the liquid from breast is often too hard and feedings may take too long. This causes the infant to expend more calories than they take in during a feeding, which can place them at risk for growth or nutrition concerns.
We encourage all mothers to pump and provide breastmilk via a specialized bottle system, as an alternative to direct breastfeeding. Kangaroo care (skin-to-skin contact), and allowing the baby to latch to the breast for bonding, is also encouraged.
Several special bottle and nipple systems have been developed specifically for infants with cleft palate to help ensure effective and efficient feeding. Some of these systems rely mostly on the infant to compress the nipple and do not require the infant to suck. These systems also include a one-way valve that makes it easier for the liquid to flow into the nipple.
There are also special feeding systems in which the caregiver simply squeezes the bottle or nipple to “squirt” the liquid into the infant’s mouth. The feeding system that works best for each infant is based on the infant’s anatomy, family preference, and trial-and-error with the child’s feeding specialists to determine which system is most effective and efficient.
Parents may also see “nasal regurgitation” with feedings before their child’s cleft palate is surgically repaired. This means that liquid may come out through the nose during or after feedings. This does not hurt the baby or mean that the baby is choking. Feeding the infant in an upright position may be helpful to decrease the amount of liquids that goes into the nose. This typically resolves after the cleft palate is repaired around 10-12 months of age. For additional information on tips for how to feed your baby after palate repair, click here.
Given the importance of helping babies with cleft palate feed, grow, and thrive in their first weeks and months of life, we have developed a specialized Cleft Lip and Palate Center Feeding Team at Nationwide Children’s Hospital. This team works with infants and their caregivers to provide education, support, and resources to ensure feeding and growth success and to help families prepare for their child’s surgery.
For more information about the Cleft Lip and Palate Center at Nationwide Children’s Hospital, click here.
Adriane Baylis, PhD, CCC-SLP, is a speech scientist, craniofacial speech pathologist and director of the Velopharyngeal Dysfunction Program. She is also an assistant professor of clinical plastic surgery, speech and hearing science, and pediatrics at The Ohio State University.
Lauren Madhoun, MS, CCC-SLP
Lauren L. Madhoun, MS, CCC-SLP, BCS-S is a speech-language pathologist at Nationwide Children’s Hospital and a member of the Cleft Lip and Palate-Craniofacial Center team. Her clinical work focuses on the assessment and treatment of children with dysphagia, specifically those with craniofacial anomalies.
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