Lifelines, an AWHONN publication had the following in their
:Conversations With Colleagues: column in the August 1997 issue that I
received yesterday:
Q: The literature seems to support that breastfeeding can be done for
babies with cleft lip and palate defects.  Does anyone have first-hand
experiences about this?  RN; North Dakota
A: I'm a nurse and mother of a bilateral cleft lip and palate child.  She
was born iwthout any plate, soft or hard, and with a floating mandible.
she's now 11 years old.  Initially, she was bottle fedwith the squeeze
bottle from Mead Johson and the lamb nipple.  But even this was
difficult.  It took 11 surgeries to close the palate.  She used an
obturator at 15 months, and I'm not sure if she could have used one any
earlier.  She has since had several grafts to close the osft and hard
palate without complete success.  However, her speech was maintained with
speech therapy and the obturator.
She has never really been able to use a straw or blow a whistle.  Two
years ago, a craniofacial surgeon wove the temporalis muscle through the
facial fossa, while maintaining its insertion site as a graft for the
palate.  She now has almost complete papate closure.  Recently, she had a
bilateral bone graft using cranial tissue to reapir and close the
mandible.  We are still waiting to see if this will work.
The point is, each situation witha cleft lip is so significantly
different, it is hard generalize.  to fit an obturator requires dental
castings, and to do so at such an early age might be very traumatic for
the child.  Bottle feeding is probably most appropriate.
Anna Alexander-Doelle, RN, BSN, Marshfield, WI
Responses can be sent to "Letters to the Editor, AWHONN Lifelines, 700
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