Patricia writes re: baby with cleft palate ;
.  Baby is 4 months old and was at breast for 2 days, when mom was told to
not bother because he
> would not be able to feed at the breast.
> ... lip surgery 2 weeks ago...The surgeon ... has said that baby has no
suck.  Mom tells me that he did have in the beginning...doc forbid any time
at breast or any feeders that necessitated suckling. He will not have his
palate surgery until he is 9 months old.

> This mom has called me to help her baby to breastfeed.  When the 2 weeks
> after lip surgery was up and she was allowed to put baby to the breast he
> didn't know what to do and he resisted being there.

Well, Pat, here's about a dime's worth of my  2 cents:

1. Do you think that this baby who has  "never suckled" for his milk will,
at 4 months of age,
be able to retrieve that instinct--at breast or bottle?

I think that at 4 months this child has the ability to learn to feed at the
breast. He has a mom who is motivated and caring and they have you to  work
with them.

2.  I don't know what skills the different (babies with cleft palate) do,
in fact, have. .

I am in this position often myself.  With any baby.  Regardless of what
labels and diagnoses they have, I like to start at the beginning and assess
for the positives that I can use to build new skills on.
Think about things like temperament and  muscle tone and developmental
progress... can baby hold his head up?  ...how much support will he need
for his body?  Does he relate warmly to mom? ... to being held?

3. He seems to have some oral aversion, not surprisingly.

This will likely be your biggest obstacle.  Your most useful tools will be
patience,  praise for small steps in the right direction and some thing
called successive approximations - stepwise goals that take tiny steps
toward your big goal.

4. Will bottle feeding with Haberman or such be a good beginning for him?

I don't know.  My instinct would be to transition from what ever is being
used now to finger feeding with a suplementer for good milk flow control -
you'll need to experiment to find the right rate - mom will also be able to
find out what he's doing with his tongue all this time ...and  then
transition to the breast with the same supplementer rate.

After the baby allows the breast in his mouth and finds that he gets mommy
milk from that source - I would encourage breast compression/massage in
addition to the use of the supplementer.  He may not be able to stimulate
the breast enough to get the whole meal on his own

At the breast he may benefit from a more upright position, and careful
notice as to the location of his mouth on the breast since he may not be
able to effectively create enough suction to maintain a good latch on his
own.

5. I suggested skin to skin while she holds him.

Sounds like a good idea for both mom and baby.

6. If his palate is greatly effected are her efforts in vain? I am mainly
stressing patience, respect for baby, and "there is plenty of time."  My
focus would be to have baby comfort suckle at the
> breast even if most of the milk intake is with bottle.

If mom is realistic and flexible with what she will try and what she
considers succeeding with breastfeeding then the time spent will be
worthwhile.  Your approach sounds like a good one.

7.  Milwaukee Cleft Clinic is reputed to be very anti-breastfeeding.

It's probably just not part of their agenda.  When they find that
Breastfeeding will be of benefit to them financially and in relation to
patient referrals - they'll change.


Good luck with this new challenge.  It sounds like it will provide the
opportunity to  learn new things that you can use to help others.


(my answer to you is based in part on my experience with a child with W-Z
syndrome -which includes cleft palate/pierre roban sequence  and a child
with trisomy 22 -mosaic -includes high palate and hypotonia)

Gail
Gail Hertz, MD
Pediatric Resident
author of the little green breastfeeding book - disclaimer: owner of Pocket
Publications