I have worked with many breastfed babies with cleft lip/palate over the
years. While challenging, the rewards are wondeful for the family (and me!).
I use the following bibliography and hints when I lecture and thought I would
share them with all of you. Please feel free to use them as you see fit.
Enjoy!
Cleft Lip/Palate and Breastfeeding Bibliography
Broad F: The effect of breastfeeding on speech quality. N Z Med J 1972:
78:28-31
Curtin G: The infant with cleft lip or palate: more than a surgical problem.
J Perinat Neonatal Nurs 1990; 3:80-89
Danner SC: Breastfeeding the infant with a cleft defect. NAACOG's clinical
issues in perinatal and women's health nursing 1992; 3:634-639
Danner SC, Cerruti ER: Nursing your baby with a cleft palate or cleft lip.
1984; Childbirth Graphics, P.O. Box 21207, Waco, TX, 76702-1207
Darzi MA, Chowdri NA, Bhat AN: Breast feeding or spoon feeding after cleft
lip repair: a prospective, randomised study. British Journal of Plastic
Surgery 1996; 49:24-26
Herzog-Isler C, Honigmann K: Give us a little time: how babies with a cleft
lip or cleft palate can be breastfed. Medela, Inc; 1996
Jocelyn LJ, Penko MA, Rode HL: Cognition, communication, and hearing in young
children with cleft lip and palate and in control children: a longitudinal
study. Pediatrics 1996; 97:529-534
Markowitz JA, Gerry RG, Fleishner R: Immediate obduration of neonatal cleft
palates. Mt Sinai J Med 1979; 46:123-129
Mohrbacher N: Nursing a baby with a cleft lip or cleft palate. La Leche
League International 1994; Publication #122
Stutte P, et al: The effects of breast massage on volume and fat content of
human milk. Genesis 1989; 10:22-25
Weatherley-White RCA, Kuehn DP, Mirrett P, et al: Early repair and
breastfeeding for infants with cleft lip. Plastic & Reconstructive Surgery
1987; 79:879-887
Videos
Herzog-Isler C. Video showing breastfed infants with cleft lip and cleft
palate, 1994. Order from: C. Herzog
Pilatusstrasse 4, CH-6033 Buchrain
Switzerland
Telephone/Fax 0041 (0) 41-440 22 14
The Special Touch Babies Need: Caring for the Infant with Cleft Lip/Palate.
1996. Order from: The Children's Mercy Hospital
Marge Ellgen
2401 Gillham Rd
Kansas City, MO 64108
© 1997 Marsha Walker, RN, IBCLC
Breastfeeding Tips for the Infant with Cleft Lip/Palate
o facilitate breastfeeding immediately (right from birth)
o early feedings are experimental for baby and mother; keep the areola soft
for easy latch-on
o express colostrum/milk at latch-on and use alternate massage to sustain
sucking during the entire feeding
o position baby upright with nape of the neck level with or slightly higher
than the breast
o with a unilateral defect, the breast should enter the mouth from the side
on which the defect is located (cradle hold on one side to a clutch hold on
the other is an example)
o some babies do well in a sitting position; use what works best
o make sure mother is comfortable during feedings and views these as primary
times for interacting with the baby; feedings can take 30-45 minutes or more
o the breast must be held into the infant's mouth for the entire feeding and
the infant must be held to breast
o the mother's thumb can cover a lip/gum defect to create a seal; she may
also need to compress the areola as she inserts it into the baby's mouth
o position the baby with a bilateral defect directly facing the breast,
sitting with legs straddling the mother's body as he faces her; the baby can
also be seated on a pillow to the mother's side under her arm
o the breast may need to be angled to the side, up, or down depending on the
extent of the defect and what works best for the baby
o mothers may need to rent an electric breastpump to maintain their milk
supply and provide supplemental milk as necessary
o expressed milk, especially the fat-rich hindmilk, can be fed to a baby with
a supplemental nutrition system, gavage tube taped to the breast, or a cup
o weight checks are advised every 3-4 days at first
o have the parents ask whether a obturator can be used to make feedings
easier
o if a baby is transitioning from a bottle to the breast, consider using a
supplemental nutrition system at the breast; pressure can be applied to the
SNS after each gum compression (milk flow into the baby's mouth helps
regulate sucking)
o it is easier if the baby is at least fed intermittently from the breast
right from the start
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