World Breastfeeding Week (part 5)

Every mother and baby is unique, so it is not possible to give hard and fast rules to follow. Some babies feed easily and others take more time to find a way that suits them, even if they have the same type of cleft. Try and give yourself time to sit comfortably and be relaxed. Make sure your baby is given enough time with one method of feeding before trying alternatives.

Common methods to help with feeding a child with a cleft

Some methods commonly used to help babies with a cleft feed more effectively are:

  • Identifying the difference between quiet dummy sucking (where the baby just breathes and sucks) and effective sucking (where the baby coordinates sucking, breathing and swallowing). This can be done with the help of a feeding specialist.
  • A different approach to breastfeeding, such as a new position. A feeding specialist can advise you on this.
  • A differently shaped teat with a larger or differently-positioned hole.
  • Very occasionally, a thin feeding tube may be passed into the stomach through the nose or mouth, called a nasogastric or NG tube. It is usually used to help babies who have a small jaw, such as those with Pierre Robin Sequence (is a condition in which an infant has a smaller than normal lower jaw, a tongue that falls back in the throat, and difficulty breathing. It is present at birth). This is usually used together with breast or bottle feeding.
  • Sometimes, the baby is given a small feeding or orthopaedic plate to wear on the roof of the mouth. This is made by an orthodontist to assist with breast feeding (as it helps the baby to form a vacuum), protect the delicate tissue in the roof of the baby’s mouth, and to keep the baby’s tongue out of their cleft. However, not all Cleft Teams agree on the benefits of using these plates, so their use is quite rare. Sometimes special orthopaedic plates can help to start closing and aligning a cleft palate prior to surgery, and if this is the case the orthodontist will need to see your baby regularly to make adjustments.

Oral Hygiene

Babies do not produce very much saliva during the first two months of life. With a cleft palate, milk can enter the nose during feeds, and while breast milk does not irritate the delicate tissue here, formula milk can leave deposits which may result in a snuffly baby. Formula-fed babies may require 2/3 teaspoons of cooled boiled water after a feed to ensure that any milk is removed from the nasal airways.

Children with a cleft that affects their gums are especially vulnerable to tooth decay, as the position of their teeth can be crooked or twisted and therefore harder to clean. As they grow older and get their milk teeth, maintaining good oral hygiene by cutting down on sugar and regularly visiting the dentist is essential.

Weaning is the process by which babies who were fully reliant on milk are introduced to solid foods. It starts with the first mouthful of food and ends with the last feed of breastmilk or formula milk (1). When and how solid foods are introduced is vital to establishing healthy eating habits and limiting fussy eating.

Other Queries related to Cleft Lip or/and Cleft Palate –

a) How will I feed my baby after surgery?

Individual circumstances will vary, so it’s best to ask your Cleft Team so that if there are to be any changes you will have time to let your baby get used to them first.

After a lip repair surgery, you can usually start feeding your baby again by breast or bottle straight away. In some cases, surgeons will recommend you feed your baby using a cup and spoon method for a while. Some Cleft Teams feel that sucking on a dummy after surgery will damage the repair, so it’s best to ask to be sure.

The timing of palate repair surgery will vary, so depending on your child’s age they may be weaned but still using a bottle for milk or other liquids.

Some surgeons prefer you not to use a bottle immediately after the palate operation, so ask your team for advice, as you may need to get your baby used to a spoon bottle or short spouted trainer cup before the operation. The same may apply to a dummy.

b) How much weight should my baby be gaining?

All babies can lose up to 10% of their birth weight but usually regain it in two to three weeks. If a baby is having five to six wet nappies a day and regular motions, is healthy and alert, these are indications that they are being fed enough.

If you are concerned, contact our hospital official website, you can also book a consultation with our doctors during hospital OPD timings (Mon-Sat from 9:00-17:00 IST). Sometimes, babies will need to be given high-calorie milk to help them take in enough nutrition.

c) Do babies with a cleft have issues with wind?

All small babies require winding and your baby will usually let you know when they are uncomfortable. If the milk flow is correct, your baby will not have more wind than normal. You may hear a ‘hissing’ sound during breastfeeding if your baby has a cleft lip, which indicates they are not forming a proper seal around the breast and are swallowing too much air. If your baby appears to be windy try stopping 2 or 3 times during the feed to burp the baby.

d) Why is milk coming down my baby’s nose?

If the flow is too fast, milk may pass into the nose through a cleft palate and cause sneezing, or some milk may come down the nose if your baby is being sick. Your baby will normally clear this but have some tissues or cloth to clean the mouth and surrounding area of the baby after or during feeding.

 For more information about Cleft lip or/and palate surgeries, visit our hospital official website

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