What you need to know when feeding an infant with a CLCP Cheryl Raysby Park MA/CCC SLP Sanford Children’s NICU

Key Issues for feeding babies with clefts Type of Cleft Breastfeeding Weight Gain Bottles & Nipples Feeding Instructions/Positioning Feeding Follow Up

Strong Support & Follow up with a cleft team including a feeding expert Most important is good nutrition for healing, for brain growth and development Good growth means better repair Good nutrition means easier and better healing Sometimes, that can mean an alternative feeding method in order to achieve good growth and nutrition. Sanford Children’s Cleft Lip and Palate Team led by Dr. Patrick Munson, Pediatric ENT. Recognized team by American Cleft Palate-Craniofacial Association and Cleft Palate Foundation. This designation is the gold standard in this field.

Feeding a baby with cleft lip Babies with cleft of lip only can usually be fed by breast or regular bottle. During breastfeeding, the soft breast tissue often will fill the opening in the lip and/or gum line. This seals off the mouth and allows baby to create enough suction. Sometimes it helps to hold a finger across the cleft while baby feeds For bottle feeding, using a nipple with wider base may be most successful.

Best Position to feed baby with a cleft

Feeding baby with cleft palate Position baby semi upright. Feed with ears higher than mouth. Do not feed in traditional cradled position. Babies with clefts may swallow more air during feeding due to the difficulty forming a seal on the nipple. Stop a minimum of 2-3x each feeding to burp baby. Oral Hygiene

What bottle to use for feeding infant with cleft palate Babies with cleft palate usually need special bottles and techniques to feed well. Rarely can babies with cleft of palate breastfeed effectively With cleft palate, baby cannot create suction to get milk out of the breast or bottle No one system is successful with every baby. Need to try many. Babies with CL/CP are at no greater risk for aspiration at any stage of development. It is a Feeding issue not a Swallowing issue.

Pigeon Nipple Easy to use/minimal variability btw. feeders Baby has complete control over bolus Durable Can fit the valve into other nipples if necessary HOWEVER Faster flow than other systems Difficult to obtain for families Nipple tends to collapse if not used with a vented bottle Difficult to provide external pacing $23 (nipple & bottle) Amazon/$9 nipple

Haberman Feeder aka Medela Special Needs Feeder Many Pieces Looks different than other bottles NO LID Not easy to use Parents feel as if they are drowning their infant Feeder variability DIFFICULT TO OBTAIN About $30 a piece on Amazon Sanford Home Medical Does carry

How to use the Special Needs Feeder by Medela Not widely used anymore Too variable of a flowrate Since the feeder must squeeze the bottle it can result in too fast of a flowrate and infant may cough/choke.

Dr. Brown’s Specialty Feeding system with one-way valve Lots of pieces Looks like a regular bottle/parents like this The internal valve converts the bottle to a compression only bottle Able to use various flow rate nipples. May start with a Level 1 and then can advance as needed.

Sophistication of the Family How will they be able to get more bottles to feed their baby? Can they afford the bottle Do they have access? Don’t assume everyone has access to big box stores or Amazon. Help the family problem solve this. Sanford Home Medical carries various specialty bottles Do they understand how to assemble the bottle?

How do I care for the bottles and nipples? Wash in hot soapy water…. How to care for the bottles/nipples Hand wash in hot soapy water Rinse and allow to air dry Do not boil the bottles or parts Do not wash them in the dishwasher or put them in the microwave. This may cause them to soften and start to leak.

What about starting solid foods? Babies with cleft lip and palate can start solid foods at the same age as other babies. Most often this is at 5-6 months of age. Food coming out of nose, is not harmful to baby. Sneezing will usually clear the food and most babies adapt quickly and accommodate to this.

Drinking from a cup Cup feeding can also be started at the usual age, 8-12 months. Avoid spill-proof cups with valves as they require suction to get fluid. Good to use a cup with a soft or short spout that won’t affect the healing of a palate repair.

Additional Family Resources See the Cleft Palate Foundation website for a video on feeding your baby and information on how to order supplies online.

Post Surgical Repair Feeding Begin introduction of this cup prior to surgical repair Good feeding option as the slits in spout can be modified for flow

Post Surgical Lip Repair Physician preferred feeding choice post cleft lip repair