General Info
- Cleft lip only infants do not have difficulty with breast-feeding or bottle feeding.
- At first, there may be some difficulty with latching on to the bottle.
Cleft palate
• Breast-feeding and bottle feeding with a regular nipple is very difficult due to enlarged sealing chamber around nipple
Feeding Concerns
• Weak, and inefficient suck • Decreased oral intake
• Prolonged feeding time
• Poor weight gain
• Parental anxiety
• Fatigue (infant and caregiver)
– The time it takes to figure out the process (which bottle, position, etc.)
• ( Nasal regurgitation)
Successful feeding depends on many variables
- Infants gestational age-34 weeks feed
- Overall medical status
- Infant’s level of alertness
- Infant’s muscle tone, energy level, and endurance
- Attitude and experience of the parent/caregiver
Guidelines for feeding a cleft infant:
• Selection of the most appropriate bottle and nipple
• Use of a feeding schedule ( feed every 21⁄2-3 hours )
• Limit feeding to 30 minutes
– Don’t overstimulate and make them too tired
• Weigh infant weekly
• Feed upright position and or sidelying.
– Upright: To prevent the liquid from going up their nose
– Sidelying: slows down the flow
What to watch for :
• Coughing/choking • Fatigue • Extended feeding time • No increase in oral intake • Nipple collapse – Sometimes the flow rate is too fast; can’t handle the amount • Spillage around lips
Need to decrease flow of nipple
Cough/ choking
Lip spillage
Need to increase flow of nipple
Fatigue
Extended feeding time
Nipple collapse (because they’re sucking so hard trying to get more out
No increase in oral intake
Augmentative Bottle Systems Include:
- Haberman/Special Needs Bottle
- Pigeon Nipple and Bottle
- Mead Johnson Nurser (very commonly used)
- Dr. Brown’s Medical Specialty Feeding System ( new) or Y-cut nipple
Haberman/Special Needs Bottle/Nipple
- Silicone nipple unit (lasts longer)
- Three flow rates
- Valve closes between sucks
- Nipple will fit standard bottles
- Light pressure/squeeze can be used on chamber
- Good nipple for very weak suck
Pigeon Nipple
• Non-latex nipple with valve
• Nipple is larger than standard nipple unit
• Nipple has one side that is soft and one side that is firm ( firm side to palate )
•Rate of flow can changed by tightening or loosening the cap of the nipple unit
– But if it’s too loose then it will leak •Nipple requires no squeezing •Nipple unit can fit standard bottles
Mead Johnson Nurser
- Non-latex cross cut nipple
- Squeeze bottle method
- Pressure to the bottle should be in sync with the infants suck/swallow pattern
- Rate of flow can vary according to how the feeder squeezes
- Leakage around collar
Dr. Brown
• Infant has a pretty organized suck burst
– Some can suck and stop, others can suck w/o stopping to breath
• Makes compression more effective
• Feeder does not assist with flow
• Multiplenippleflowratestoselectfrom • Nipple Last longer
Goal of Feeding
• Promote caregiver bonding
• Assure safe, functional feeding in a timely manner
• Increase oral intake
• Promote weight gain(10lbsbeforeliprepair)
• Allow for normal sucking
– Not that every infant achieves that w/ a bottle and move onto cup drinking
• Conserve energy
• Be an enjoyable experience
Feeding older infant
- Same as with any infant.
- Most infants ready to transition to the cup by 8 or 9 months. Some show readiness earlier.
- Some surgeons recommend weaning to cup drinking before palate surgery.
Before palate surgery
- Solid foods can be introduced to the baby the same as with any infant.
- May see nasal regurgitation at first but improves with time.
- Have the infant drink water after eating will help clean the oral and nasal cavities.
Feeding Obturators
Different views regarding the use of palatal appliances for feeding
• Pro: Some teams report increase weight gain
• Con:
– Cost- ? Insurance coverage
– Hard to insert appliance
– Irritation to oral tissues
– Ongoing replacement because of growth
