You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Supplementing the Breastfed Infant with a Cleft

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SUPPLEMENTING THE BREAST FED INFANT WITH A CLEFT
by Joan McCartney IBLCC

After choosing to breast feed your baby your choice may have been challenged at the time of her birth, when it was discovered that she has a cleft lip and palate. Still, you resolved yourself to try your baby at the breast. If you were fortunate, you found that few problems accompanied your attempts to feed your child human breast milk at your breast. However, it is more likely that you and your baby did experience some frustrations. This is not necessarily an indication that you may not feed your baby as you had hoped.

Your baby may need supplemental bottles of pumped breast milk after some of her feedings until she is bigger and stronger. As her weight increases, so also will her energy for more effective suckling. In fact, pumping your breast will very probably be a part of your nursing routine in the early weeks. It provides extra stimulation to make more milk and offers the baby bonus calories. Milk at the end of a feeding has a higher concentration of fat and is needed for weight gain. Pumping when the baby is finished but has not emptied the breast collects the "leftovers". There are some good publications about pumping and storing breast milk that can be obtained from La Leche League in your area.

When offering supplements, squeezable bottles with wide-based crosscut nipples work well. The wide base reminds the baby to open his mouth, which is important for breast feeding. You may want to consider using a Haberman Feeder for supplemental feedings. The feeder was designed for infants with suck dysfunctions, such as those with clefts, and has a unique wide-based nipple and special valve which imitates breast feeding by working on a pumping action rather than by sucking. It is sold by the Illinois-based Medela Company at a cost of approximately $15-$20. (For information you may call 1-800-435-8316.)

Use of a supplemental nursing device may or may not work for you and your cleft palate baby. Such a system consists of a bag or bottle which hangs upside down around the mother's neck. Very soft plastic tubing extends from the neck of the bottle or bag to the mother's breasts where they are held in place with low-stick tape. The baby receives supplemental milk while at the breast. Mothers who have found it useful claim that it was helpful in preventing the baby from becoming "nipple confused". (There are different mechanics involved in using artificial nipples) Keeping the baby at the breast for all feedings helped to improve the milking technique and was an aid in satisfying the sucking urge, which is difficult to appease with a pacifier. The extra stimulation of the mother's breasts reportedly booster their mild supply as well.

On the other hand, some women have not found the supplemental nursing devices to work well due to the fact that they require suction (Note: there are some systems that claim to function by using gravity. Suction, therefore, would not be necessary to use those systems.) Squeezing on the bottle or bag to compensate for the lack of suction called for continuous pressure and was tiring. Squeezing on the bag forces the milk to flow to its top, but the tube is attached to the bottom. Some mothers also found it to be cumbersome, requiring an extra hand.

Lactation consultants and nursery staff professionals have helped to establish good breast feeding patterns with the use of a 20cc syringe plunger and a #3 or #5 feeding tube attached to it. The other end of the tube is secured to the mother's breast using low-tack tape, with the tip extending slightly beyond the nipple. (much like it is with the supplemental nursing services). A gentle push on the plunger follows each gum compression action. In contrast to many supplemental systems, suction is not required and the milk cannot be drawn back through the tube and away from the baby.

When employing any kind of assisted feeding method, consult with an experienced professional. Too rapid a delivery of milk can be potentially dangerous for the baby.

Mothers have expressed concern that breast feeding will have to end when the baby is scheduled for surgery. Not necessarily true. Always ask your surgeon first. Lip repair is usually performed on the very new infant. Since breast milk is a living tissue it is well tolerated and digests rapidly. Many physicians therefore allow mothers to nurse their babies closer to the time of surgery and sooner, if not immediately, afterward. Human milk contains an antibacterial agent called lysozyme which may very well promote faster healing be stimulating a good blood supply.

Breast feeding after hard palate repair may be temporarily contraindicated. Some surgeons give the go-ahead sooner than other feeding methods, but the baby himself might refuse the breast for a week or two. Pumping your breasts during this short period will relieve your discomfort, maintain your milk supply, and provide the baby with the finest health food available, which he can drink by the cup or syringe (as approved by your surgeon).

Whether you are learning with your newborn, or pumping milk to soothe your post-operative older baby, contacting other families who have had similar experiences will be beneficial. Your pediatrician, surgeon or craniofacial center should be able to provide you with a "buddy" family. Take care of yourself. Eat well and do not be afraid to ask family members and friends for help around the house or with the other children. Acknowledge the fact that some days will be overwhelming. Life with any newborn is not always a piece of cake!

Your baby will be tiny for only a very short time. Enjoy him as the little person he is and take pride that because of you and your milk he continues to grow.


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