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Congratulations on the birth of your new child. A new baby brings out many feelings of joy, pride, awe and sometimes fears. When the baby has a medical condition, there is an additional feeling of uncertainty. Who will help our baby? What will our baby have to go through? How will we tell our family?
We understand the strength of your feelings and want to help. Feeding is one of the first and most basic needs that parents fulfill for their child. This pamphlet will give you some direction and information about feeding your infant born with a cleft lip, a cleft palate or both.
The most immediate concern for a baby with cleft palate is good nutrition. The opening into the mouth from the nose causes a leak of air that prevents effective suction. If the infant has only a cleft lip, there should be no loss of suction and the infant can suck well from a bottle or a breast. When the gum and lip are cleft, the infant’s suction may be reduced and the baby might need a bottle with a freer flow rate, such as one of the vented bottles on the market, or a juice nipple. Some parents find that pushing the two sides of the lip together without blocking the nostrils restores suction immediately. The following are suggestions to help you decide how best to feed your baby.
• Breastfeeding an infant with a cleft lip but no cleft palate will be successful, but sometimes requires a changed feeding position so that mother’s breast tissue fills the gap in the lip or gum.
• Breastfeeding an infant with a cleft palate is quite challenging unless the infant’s cleft palate is very far in the back of the mouth and very small. Nursing at the breast is best limited to 10 minutes, and supplemental bottles are needed if breastfeeding alone does not supply enough food for adequate satisfaction and growth.
• For most mothers of infants with cleft palate, breast pumping should begin in the birth hospital using a high quality electric breast pump and continue after each infant feeding.
• A lactation consultant is a breastfeeding mother’s best resource for correct positioning and pumping technique. Discuss your feeding plan with this specialist before discharge from the hospital.
• Small, frequent feedings are usual in the first weeks of life for an infant with a cleft palate. Give yourself and your baby time to learn how to eat, and expect longer than expected feeding times. Try to limit feedings to 30 minutes with an additional 10 minutes for burping and changing.
Having a cleft palate prevents an infant from making enough suction in the nipple to draw out formula or breast milk.
• Hold your baby up in a semi-upright seated position, to limit the amount of liquid that enters the nasal passage, with the head and shoulders in one hand and the bottle in your other hand. If you are more comfortable with the baby in the crook of your elbow, place a folded blanket or flat pillow under that elbow to hold the baby more upright. Some infants totally ignore drainage into the nose and you should not be alarmed to see a trickle come out. If there is a great amount of liquid in the nose, or if your baby spits up, tilt the baby forward. Your baby will swallow any extra milk in the back of the throat and the extra milk in the front of the mouth and nose will drain out by gravity. You may use a bulb suction to help, but the positioning is important to prevent any extra liquid from sliding to the back of the throat.
• Hold the infant so the head, neck and shoulders are in a straight line, or with the chin slightly tilted toward the chest.
• Tickle the baby’s lower lip or corner of the mouth with the nipple and place it over the tongue when the baby’s head turns toward the nipple and the mouth pops open. You may need to pull the lower jaw down gently to get the baby’s tongue down and out of the way.
• When any of the nipples are placed in the mouth, allow your baby to suck and breathe a few times before beginning any compression of either the Mead Johnson Cleft Palate Nurser bottle or the Haberman Feeder. Begin with gentle compression and slowly increase the pressure while watching your infant’s face which should remain calm. For the Pigeon nipple, place the nipple in the mouth parallel to the floor so that it does not fill completely for the first few swallows. Once the infant has been comfortably breathing and feeding, you may lift the bottle so that the nipple fills more fully.
• Remove the nipple from your baby’s mouth if you see any signs of distress, such as the head pulling back, no breath for 3-4 sucks, coughing or an alarmed look on your baby’s face. When calm behavior returns, begin again more slowly.
• There is little you can do to control the amount of air swallowed during feedings. Your baby will need to burp frequently, but don’t interrupt the feeding too much. For very young infants, all you will have to do to is straighten up the baby by pushing gently up at the back of the waist and lifting the front of the chest with the other hand.
• There is a Y cut in the tip of the nipple. Roll the tip with a clean cloth to loosen the opening.
• Notice the V in the base of the nipple.
This is the air vent, and must be positioned on the top of the nipple under the infant’s nose for the nipple to work properly. If the nipple collapses or leaks from that hole, remove the nipple from the cap and massage that area to unclog the vent and dry the passage. You may need to poke a toothpick through the vent to clear it.
• If the bottle system is purchased, follow package directions for assembly. If only the nipple or valve is purchased, you must find a nipple ring that fits. The nipple ring from the Enfamil bottle may be used as well as rings from other commercial bottles. First, put the nipple securely in the nipple ring. Next, put the valve in the base of the nipple smooth side toward the tip until the other side of the valve is level with the rim of the nipple.
• Put the nipple in baby’s mouth normally. The infant’s tongue will activate the flow. If the nipple collapses, you can unscrew the cap and re-tighten it more loosely. Problem–solving: When nipple collapse is a frequent problem, some parents have successfully placed the Pigeon nipple and valve in a vented bottle system (i.e. Dr. Brown Natural Flow Baby Bottle). Other parents have slightly enlarged the “Y” cut.
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• Assemble the bottle and fill with breast milk or formula according to package directions. The side of the disk with the 
holes will face the bottle, and the smooth white disk will face the nipple.
• Line up the shortest line on the compressible reservoir with the baby’s nose and tickle the lower lip. Insert the nipple when the mouth opens. Position the nipple on the center of the tongue with the tip turned under the intact part of the palate. The infant will begin to suck. Rotate the nipple until the longest line and greatest flow is under the baby’s nose. If your infant cannot tolerate the flow, rotate the bottle back to a slower rate of flow. You may compress the reservoir every second or third suck, or put continuous pressure on the section so that more milk will come out of the nipple when the baby compresses the nipple between the palate and tongue.
• The Enfamil Nurser bottle comes with a narrow, cross cut nipple. Any commercial nipple can be used with the compressible bottle if the tip of the nipple is cut in a 1/8 to 1/4 inch “X”.
• If the baby takes more than 40 minutes to eat, or if there is leakage from the nipple ring, it may improve feeding efficiency to increase the crosscut about 1/16th of an inch. Any time the nipple opening is enlarged take care to squeeze less until you know how much the flow of formula has increased.