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It's unusual that a baby with a cleft of the soft palate can breastfeed
directly. I would want to know how much milk mom is pumping per 24
hours, and how much the baby is taking. A little girl at 3 mos generally
takes about 23-26 oz, according to Hartmann's research group.
If baby cannot make the Haberman work well, but mom is able to pump more
milk, perhaps using the Pigeon nipple will be better for this baby.
Pigeon is a Japanese brand, but they are readily accessible on the net.
The nipple is soft on the lower (tongue side) half, and firmer on the
palate side half, and yields a strong spray of milk with slight
compression by the tongue. If the baby cannot make this work, perhaps
she will fingerfeed with a syringe and tube, with mom pressing milk from
the syringe in concert with the baby's sucking movements. This can also
be done at breast to give baby the illusion of breastfeeding, it worked
well for a little girl with a cleft soft palate in my practice.
Regular bottles don't often work well for babies with clefts, they
require too much negative pressure, and a baby with a cleft can't
generate any unless the nose is occluded!
Another issue to check is that the baby is not getting milk into her
nasopharynx, if so, she might be so uncomfortable that she becomes
unwilling to feed unless she is "starving". Some babies self limit
intake due to pain from reflux or improper swallowing.
Catherine Watson Genna, IBCLC NYC
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