Feeding Guide

INTRODUCTION


The birth of a child is a joyous occasion. But the birth of a child with cleft lip and/or palate deformity can come as a shock and disappointment. This in turn could cause feelings of rejection, horror, guilt, depression or anxiety in both parents, most often the
mother.


Cleft is a term used to describe a gap or a split in the structure of the lip or the roof of the mouth. It is a congenital phenomenon affecting 1 in about 600 – 700 new born babies. It should be noted that cleft on its own, without any syndrome associated to it,  is not life threatening and can be repaired successfully.


Babies with cleft will have some feeding problems initially. A lot of time, care and patience are needed to successfully feed a cleft baby satisfactorily. Proper feeding is important as weight and general health are usually considerations in order to undergo cleft repair surgeries. Not getting enough milk and hunger will also make the baby cry and may demoralize the mother.

 

Some suggested methods of feeding are:


1. Breastfeeding

2. Bottle feeding with spoon feeder (Softplas, MAM soft bottle, Haberman)

3. Bottle feeding with special teats  (MAM orthondotic teats, NUK )

4. Nasogastric tube

5. Syringe

6. Spoon

7. Cup


FEEDING OF CLEFT BABIES


Breast milk is still the best but having the cleft will be a great challenge to the mother. Babies with cleft lip can usually be breast fed successfully if the mother is keen. For more info please visit http://www.bfmed.org/Resources/protocols.aspx , (Article No.17). If the baby is unable to suckle from the breast, then the expressed breast milk can be given in a bottle with a special teat, a spoon feeder or a spoon directly.


Length of time: Cleft babies tend to suck slower so the feeding time may take longer. If your baby gets tired, shorten the duration of feeding but increase frequency . Do not be discouraged but continue to let the baby suckle as the sucking motion 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 feeding with teats may injure the suture 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 prevents the milk from going into the middle ear which may causeear infection due to fluid build-up.


Post-Surgery: After a surgery, feed the baby using the bottle with 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.

 

 

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