Does your little one have a cleft lip/palate? (Cleft Lip/Cleft Palate) – Let's talk about breastfeeding!

Oh, was your little one born with a cleft lip or palate? As a mother, you probably have a lot of thoughts when something like this happens. But don't worry, many babies are born with these things. The most important thing is to give the baby the right amount of milk so that he or she gains weight well and doesn't get dehydrated. Sometimes these babies need a little special help to drink milk.

How to breastfeed a baby with a cleft lip?

In most cases, babies born with a cleft lip and no palate problems can breastfeed well without any special equipment. They can breastfeed normally or use a regular bottle. Sometimes all that needs to be done is to adjust the latch a little so that the baby can latch on properly . If you are breastfeeding, try changing the position of your baby so that your breast fills the gap between your breasts. This will help your baby suckle more easily.

What are the challenges of breastfeeding a baby with a cleft palate?

However, babies born with a cleft lip or palate, whether with or without a cleft lip, have difficulty sucking directly from the breast. The reason for this is that they cannot create the pressure inside their mouths to extract the milk from the nipple. Think of it like when we drink something through a straw, we need to create a vacuum inside our mouths. That is why it is difficult for these babies to do something like that because of the cleft palate. If you try to breastfeed such a baby, whether you try to feed him with a regular bottle, he may not get enough milk and may not gain weight (failure to thrive) . That means the baby may not grow properly. What other problems can occur?

• When a baby drinks milk , milk may come out of the nose . We also call this ``Nasal Regurgitation''. It can be scary for mothers to see this, but it is something to be expected in this situation.
• A baby may swallow more air than a normal baby while breastfeeding, which can cause stomach discomfort.
• Sometimes, if a baby has another ``syndrome'', a collection of related symptoms, other breastfeeding issues, such as digestive problems, may occur.

What kind of bottle should be used to feed a baby with a cleft palate?

To feed a baby with a cleft palate , you need to use a special bottle system . These bottles are designed to provide the baby with the right amount of nutrition without putting too much pressure on the baby to suck. These are not like regular bottles. There are several types of cleft feeding bottle systems. Let's take a look at what they are, to make it easier for you to understand:

Dr. Brown's Specialty Feeding System

This bottle system has a one-way feeding valve that allows milk to flow in only one direction.. This stops the milk from flowing back into the bottle. This means that the baby doesn't have to suck, and can suck the milk by biting or squeezing the nipple . There are different types of nipples that have different flow rates depending on the baby's age (from very young babies (preemie) to level 3). This bottle is often easier for parents and caregivers to use . Because the baby does the work, the mother doesn't have to squeeze the bottle or hold it in a special position.

Pigeon Feeder

This bottle system also has a `one-way valve` that prevents milk from flowing back into the bottle. The `Y-cut nipple` (that is, a `nipple` with a cut in the shape of the letter Y) has a thin side and a slightly thicker side on the other side.

• The thick side should be placed along the gum line of the baby's upper jaw.
• The thin side should come up over the baby's tongue.
• The small notch under the edge of the nipple should be placed under the baby's nose. This will help you check if the nipple is properly in the mouth.

This nipple comes in two sizes. You can also adjust the flow rate by tightening or loosening the nipple. This takes some getting used to.

Medela Special Needs Feeder (Haberman) `(Medela SpecialNeeds Feeder (Haberman))`

This is also called a `Haberman Feeder` by some. This bottle system also has a `one-way valve` to keep the milk inside the `nipple`. Some babies can take milk by pressing the `nipple` against their gums. But most of the time, the caregiver has to squeeze the bottle to match the baby's sucking and swallowing rhythm :

• As soon as the baby starts sucking, squeeze the bottle tightly and then relax .
• This should only be done while the baby is sucking. Listen carefully to the sound of the baby swallowing milk .
• If the baby stops breathing for a moment, you should also stop squeezing the bottle.

It takes some practice to get the timing right . That means you need to practice squeezing when your baby sucks and stopping when they stop. The three lines along the bottle indicate the flow rate of the milk coming out of the nipple. You can adjust the flow rate by rotating the bottle so that one of the lines is under your baby's nose.

Enfamil Mead Johnson Cleft Lip/Palate Nurser

This bottle does not have a `one-way valve` . Like the `Haberman` bottle system, the caregiver must squeeze the bottle and adjust the speed to the baby's sucking pattern . This also takes a little practice.

Remember, each of these bottles is designed to make this journey a little easier for you and your baby. Sometimes one bottle doesn't work, and you have to try another. Your medical team will help you with this, choosing the one that best suits your baby.

What other tips can help?

Okay, now that we've talked about bottles, there are a few other things that can help you with this breastfeeding process. If you follow these correctly, it will be even easier for your baby.

• A feeding should be finished in less than 30 minutes . If it's taking longer than that, it could mean that the baby is having trouble getting milk, or the nipple may not be pumping fast enough. If that's the case, try using a nipple that lets milk out a little faster.
• Help your baby to burp regularly . About every 5 minutes while breastfeeding. This is because babies swallow a lot of air, so it's a good idea to do so. This will help reduce stomach upset and vomiting.
• Keep your baby in an upright position during feeding and for 20-30 minutes after feeding. This can help reduce nasal regurgitation.
• If milk comes out of your baby's nose, wipe it away with a clean cloth . There is no need to use a suction bulb to suck out the milk. Doing so can be uncomfortable for your baby.
• Although babies with a cleft palate cannot breastfeed directly, mothers can express their breast milk and feed it to their baby from a special bottle . This is very valuable, as the baby receives the nutrients and protection from diseases in breast milk.
• Also, to further strengthen the bond with your baby, you can allow him to do non-nutritive sucking . This means that the baby is just sucking on the breast for comfort, not to drink milk. This also strengthens the baby's sucking muscles. But do not let him do this for more than 10 minutes at a time.

How do I know if my baby is not breastfeeding properly?

Because of these challenges in breastfeeding, babies with a cleft palate are at risk of failure to thrive . Therefore, your baby's doctor, or the cleft team, a team of specialists who treat these cleft conditions, will regularly check your baby's weight to make sure they are gaining enough weight. This is very important. Sometimes, even with special bottle systems, babies can have feeding problems and weight gain problems. They may be uncomfortable when they are breastfeeding, and they may not be getting enough milk. You should pay close attention to these signs :

• If you are crying while breastfeeding or after breastfeeding.
• If you feel like you're choking, it's ``choking'' .
• If tears come from the eyes , it is `` watery eyes '' .
• Furrowing eyebrows (this indicates that the baby is uncomfortable).
• If you bend your body backwards while breastfeeding, it is called ``back arching'' .

If you see any of these signs in your baby, it means that he is having some difficulty breastfeeding. Then you should try making a small change in your feeding strategy.

For example:

• Limit the amount of milk your baby takes at one time, and try using a nipple that has a slower flow rate .
• Take frequent pauses during feedings. Give your baby time to breathe and let the milk go down.
• After taking a few sips of milk, tilt the bottle slightly to the side and stop the flow of milk for a while.

If you have any concerns or questions about your baby's breastfeeding, talk to your cleft and craniofacial team right away . A feeding therapist or nurse practitioner on that team will examine your baby while you are breastfeeding. They may recommend changes to your breastfeeding method or other testing. Never be alone.

How can parents help?

Breastfeeding a baby with a cleft lip/palate can be a bit challenging at first. But you are not alone, there is plenty of help . Your cleft team, a team of specialists, can provide you with the support and information you need. They are experienced in working with babies with this condition. There are many cleft teams that offer prenatal consultations if the baby is diagnosed with a cleft during an ultrasound. Parents can then meet with the team to discuss any questions they have about breastfeeding. They can then create a feeding plan before the baby is born . This can be a great relief. Let's say you suddenly found out you had a cleft after the baby was born. The inpatient staff will then help the parents find a bottle system that works best for their baby . The baby's doctor may refer the parents to a cleft team. The cleft team usually meets with the parents and baby within the first week or two after the baby is born. They will check on how breastfeeding is going and answer any questions you may have. You can also find information about this online. For example:

• American Cleft Palate-Craniofacial Association (ACPA) - There is a lot of useful information on the websites of organizations like this.

So, what are the most important things we should take home from this story?

Okay, we've talked about a lot now, haven't we? If your little one has a cleft lip or palate, breastfeeding may be a little different. But keep these things in mind:

• Babies with a cleft lip can often breastfeed normally. They may only need to make minor adjustments to their position .
• Babies with a cleft palate need special bottles because they have difficulty creating the pressure needed to suck and get milk.
• There are specialty bottles like `Dr. Brown's`, `Pigeon`, `Medela SpecialNeeds (Haberman)`, and `Enfamil`. Talk to your medical team and choose the one that works best for your baby. Don't be afraid to try another one if one bottle doesn't work quite right.
• Hold your baby upright while breastfeeding, help him burp frequently, and limit feedings to 30 minutes. These little things can make a big difference.
• If your baby is showing signs of choking or choking, it could be a breastfeeding problem. Seek medical advice immediately.
• You are not alone! The ``Cleft team'' will help you with everything. Don't be afraid to ask them questions, ask for help. They are there to help you.

The most important thing is to breastfeed your baby with patience, love, and the right methods . Even though this may seem like a difficult journey at first, you can do this. Then your baby will grow up healthy and happy. I wish you all the best in this journey!

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Cleft Lip, Cleft Palate, Breastfeeding, Specialty Bottles, Breastfeeding Challenges, Medical Advice, Infant Nutrition