Having worked with a fair number of infants with cleft defects, I will share
for a minute about issues related to the slow growing baby recently described.

 Trying to nurse with some clefts is like sucking milk out of the bottom of
a glass when the straw you are using has a big hole in it.  In this case,
the hole goes up into your nose, so that if you do manage to get some milk,
it may flow out of your nose, and some may be aspirated into your lungs
while you feed (this can occur without sounds of coughing -- silent
aspiration is common in infants).  The tongue is used in one aspect of
breastfeeding much in the way a rolling pin rolls out a lump of dough.  In
otherwords, the grouved tongue cups, but then lifts and presses the mother's
teat from the front towards the back of the mouth, up against the hard
palate to roll the milk to the rear of the mouth for swallowing.  Depending
on the size of the cleft, the infant may have no palate to supply
counter-pressure for this peristalsis, so it learns:  why make the effort to
lift the tongue.  Or, it may have been patterning tongue motions so
unusually (due to tendency of tongues to seek and explore cavities) that it
is just totally disorganized about how to use tongue appropriately, neither
lifting nor grooving -- simply trying to use gum compression to obtain milk.

The Haberman does not require suction to move milk out of its sealed
chamber.  Gum compression alone will squirt milk into mouth.  The long teat
may place the ultimate delivery of that squirt far enough back in mouth that
baby gets it going down the throat instead of up the nose.  (A big incentive
to go ahead and feed).  Also, long teat may seal off cleft and create, in
effect, an obturator-type blocking of the cleft which allows baby a sealed
off oral cavity.  The more rigid, round teat of the Haberman may also assist
the baby in forming a central groove to the tongue, which will help baby
organize the bolus of milk so there is likely to be better swallowing, less
out-of-synch spilling of milk into the larynx, less aspiration.

Does this mean that no babies with clefts should be nursed?  No.  Obviously
some can, and in my opinion, all should get opportunities to practice on a
daily basis for the oral/motor exercise benefits.  All should certainly get
human milk due to well known benefits in prevention of glue ear, other
respiratory infections, etc.  However, clearly, many such infants in prior
times died from feeding problems related to this condition, or were
deliberately exposed (infanticide) due, one supposes, to the stigma and to
the recognition of the on-going difficulties of caring for such babies.

 To feel, as some breastfeeding counselors often do, that they have failed
when they can't get these babies totally sustained at breast saddens me.  I
think that here is a situation where use of test weights is so important.
The baby described LOOKED WELL LATCHED.  But in reality was unable to obtain
enough milk to grow.  So the protection of the milk supply may well be
compromised by false reassurance when in actuality everyone should be
saying:  This problem is fixable.  Surgery will make it all right.  In the
meantime, lets help this infant grow on human milk with all our best skills
which we employ in special situations.  Here's where we are glad we have
good scales, pumps, and alternate feeding capability.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html