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This one is about: Special Considerations of the Bottle-Fed Baby with a Cleft
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SPECIAL CONSIDERATIONS OF THE BOTTLE-FED BABY WITH A CLEFT
One of the first, most vital needs your baby will have upon entering this world is to take nourishment. This is true whether your child has rose-bud lips and a perfect palate or a complete cleft. Either way, your baby will be hungry, and she will look to YOU to feed her.
It is a rare first-time parent indeed who will not have some concept concerning the feeding of a normal, healthy newborn. A great many mothers will have already made the decision to breastfeed their child and prepared accordingly. Some mothers will have chosen bottle-feeding as their method of choice. Regardless of the choices made prior to the birth of a cleft-affected child, some adjustments will probably have to be made.
It is not a foregone conclusion that an infant with a cleft can not breastfeed. However, the majority of children with complete cleft lips and palates will need some kind of supplemental help. Most will need to be bottle fed. Probably the most popular used nurser for feeding cleft infants is the Mead Johnson Cleft Palate Nurser. It is often distributed to families through the hospital in which the child was born. There are other choices. However, for the purposes of this essay, we will concentrate on the Mead Johnson.
The Mead Johnson nurser is made of soft, squeezable plastic and has a unique "flattened" or oblong shape. The nipple is longer than most "over the counter" nipples and is cross-cut at the tip. Almost any regular nipple may be substituted for the Mead Johnson nipple. Preemie nipples and Nuk, or orthodontic nipples (usually turned upside-down) are popular favorite alternatives. In most cases these new nipples must have enlarged or crosscut holes.
The most common complaint about the Mead Johnson nurser is that they have a tendency to leak around the collar. This may sometimes happen. It would be wise to use a bib or other soft cloth under the baby's chin while feeding. If some is coming out, rest assured that more is going in. (Some parents report that by replacing the Mead Johnson collar with an over-the-counter collar will reduce collar leakage.) Also, you can minimize collar leakage by not warming bottles in the microwave and not putting bottles in the dishwasher. While Mead Johnson Cleft Palate Nursers are formally listed as "disposable", they can be cleaned and used again and again for many months.
The following are some considerations to remember when feeding your cleft child:
POSITIONING: The baby should be positioned in a semi-upright position so that the milk will flow downward into the baby's stomach and not wash up and into the baby's nasal passages and up through the Eustachian tubes. Feeding the baby in a reclining position leads to contamination of the middle ear and ear infections. Always feed the baby so that his head is positioned higher than his stomach.
DELIVERY: Babies normally learn a suck/breath rhythm. When you feed your cleft-affected baby with the Mead Johnson nurser you will want to imitate that same rhythm, using the baby's own cues for your delivery. Milk is delivered through the Mead Johnson by squeezing the outside of the bottle. You may want to practice squeezing the bottle into a bowl or sink until you get the "feel" for how much pressure you want to use. When the baby is feeding, watch his jaw compressions. By using that sort of pulse delivery you are approximating a normal feeding pattern for your baby and he will do much better.
BURPING: All infants need to be burped to help expel the air that may have been swallowed during feeding. Babies with clefts tend to swallow more air while feeding and may need more frequent burping. Some mothers also report that their babies with clefts tend to spit up more often than their children without clefts. Again, more frequent burping may minimize spit-ups. Some spitting up is not a health problem, but if your child is actually vomiting or if your child is spitting up most of what is eaten, consult your pediatrician right away.
NASAL REGURGITATION: Some food will most likely escape out the nose if your baby's palate is cleft. As unsightly as it may be to those who have not been around a cleft infant while being fed, it does not seem particularly painful for the child and does not present a health risk. There are many things that babies do that would be considered disgusting if done by a more mature person. Nasal regurgitation is not different. Be ready with a soft rag to wipe away the escaping liquid and go on with the feeding. After feeding your child, be sure to wipe the cleft area clean, as well as the nose.
Some children "drip" milk from the nose for a while after the feeding is over. This is simply milk that was still in the nasal area. Again, it does not present a health risk and should simply be wiped away. You may want to follow a milk feeding with some water to help clean the excess milk from the nasal passages. Every newborn must "learn" to eat. The cleft newborn has a more difficult task before her. And so also does her parent. However, most cleft newborns and their parents eventually learn how to get nourishment into the tummy - and most often sooner than later! If you feel frustrated, then you are having a normal experience. But relax. Be flexible. Try a new method. Talk to an experienced parent. And have confidence in yourself and your child that you will conquer this obstacle together. In no time at all you will wonder at how much your "little piglet" is gobbling down!