Hi folks,

While we're on the subject, I was hoping you wise people might be able to
share some of your experiences with getting a baby back to the breast after
having cleft lip and palate repair surgery.  I'm working with a mom and her
10-week-old son who just had the repair surgery two weeks ago.  Prior to the
surgery, mom was feeding him EBM in a Haberman feeder (this smart young mom
visited an IBCLC while still pregnant).  After surgery the staff gave her a
squeeze bottle with a skinny rubber nipple and she hasn't used the Haberman
since.  Mom says she tried an Avent nipple after surgery but she thinks from
the way he reacted it irritated the roof of his mouth; maybe a rubber nipple
is softer and less aggravating than silicone?

His upper lip has just one stitch left to dissolve, but still looks
considerably stretched and turgid compared with untouched babies' lips.  The
palate feels slightly bumpier than an untouched palate, but I don't believe
it will cause any irritation to mom.  He even managed to cup his tongue and
lightly suck on my (gloved) finger during the exam, which was very exciting
to his mom and I.  He's healing beautifully but needs to regain .5# he had
lost during the surgery and recovery.

I showed mom paced bottle feeding, hoping that encouraging him to work at
getting the milk out of the bottle would be a good first step in teaching
him how to suck.  The baby took to it really well for a few minutes,
extending his tongue and cupping the (skinny) bottle nipple.  Then he
refused to close his mouth around the nipple in any position, so mom was
thinking that he needed another dose of ibuprofen.

We tried latching baby on just to see how he would react, but it didn't go
well.  He is easily upset and he was outright wailing before we could
position him.  Mom said he briefly breastfed once shortly after surgery,
while he was still getting the heavy-duty painkillers...but he DID feed!  

In that light, I'm hoping a very soft-sell approach (lots of sts, carrying,
warm baths, lying on mom's chest, etc.) will help warm him up to the idea. 
Meanwhile, I was hoping some of you might have some suggestions for bottle
nipple types, OT/PT exercises, etc., we can use to gently coax him back to
effective breastfeeding with an effective suck.  I searched the archives but
found very few ideas.  Thanks a million in advance for any tips you can share.

Debbie Gillespie, rookie IBCLC, LLLL

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