With a cleft of the soft palate, it might not matter whether the breast
is empty or full, because the baby is going to have a tough time getting
milk out of the breast. The syringe and tube is to provide breastfeeding
for the mother and baby, and to help spread the hard palate and form the
facial muscles by the baby's sucking movements, without the expectation
that the baby is actually going to get milk at the breast. Kind of like
adoptive breastfeeding at first, before there is milk. I've seen one
soft palate cleft affected baby who was able to move NO milk from the
breast at all, with or without a nipple shield, but was able to take a
few cc's from the breast when given the syringe at breast (in other
words, test weights documented that the baby got about .1 to .2 oz that
DID NOT come from the syringe). In this case, I would offer a full
breast to the baby, in the hopes that the breast would drip or spray
with the MER. If it is more difficult for the baby to stay attached to
the firmer breast, we could use a pumped breast instead. Breasts give
milk in response to stimulation, so they are easier for most babies to
handle flow from, no matter their challenge.
Some rare babies with soft palate clefts are able to use compression to
induce the breast to spray. There is an essay by one mom of such a baby
who was able to hold the breast in the baby's mouth and the baby was
able to chew out some milk. We don't understand how she managed this,
because it seems to go against the research. Moms can also hand express
milk into baby's mouth this way.
Any feedings for a cleft baby should be in an upright position, whether
by specialty feeder, bottle or breast. Though breast milk is far less
irritating than artificial milks, we still don't want it where it does
not belong.
Hope this clears up any questions, Sara.
Catherine Watson Genna, IBCLC NYC
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