I am working with a mom whose baby (almost 3 wks of age) has a bilateral
cleft of lip and gum, but not the hard palate. He also has an anomalous
growth-- looks like lip and skin tissue that was scraped to one side and
grew in a lump over the left nostril during gestation-- that blocks the one
nostril/nasal cavity. When he opens, you can look directly into the right
nasal cavity. He tends to hold his tongue high up, into the nasal opening,
but the real challenge is a combination of that open airway plus nasal
congestion.

I've never worked with this type of cleft before, and before seeing it I
thought it would merely be a matter of making a good seal with the breast
since the hard and soft palates were intact. What I discovered was that a
"good seal" of breast tissue also easily blocks baby's nasal airway, causing
him to let got after a couple of sucks in order to breathe. Tricky.

Lucky for baby, he is mom's fourth child and she had breastfed all the
others. She has been determined to breastfeed him, and she is great with the
little "chiquita". Last week we worked on teaching him to open on "command"
and drop his tongue-- he is doing much better now. Today mom showed me the
position he does best in, but her rocker did not allow her to sit
comfortably, causing tension for both. We changed to another chair, got her
all situated, and lo and behold, baby latched and actually stayed on for 10+
minutes. It was interesting to watch; he typically stops sucking after three
sucks, but here he was sustaining, swallowing, even gulping. You could see
the tension in his face and body and hear labored breathing; he was working
hard to coordinate suck and swallow with breathing. For this little guy, it
was a major victory and a beautiful sight, his first nutritive experience at
breast! According to my scale, he transferred 70ccs from one breast. I did a
double take, but it seems to be accurate.

Mom knows that it will take time for baby to work towards sustaining at
breast. But, considering the first of his surgeries will not occur before 3
mos of age, this was a great encouragement to her. And I of course was
thrilled.

Lisa Marasco IBCLC
Santa Maria, CA

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