Dear Cassie,
Feeding is difficult for infant's with clefts of the palate because they are
unable to create suction due to their inability to seal the oral chamber.
While the compression of the breast between the gums and tongue (creation of
positive pressure) can sometimes compensate, it has been my experience that
even small clefts of the palate create significant breastfeeding problems.
This does not mean that human milk is not vital to these babies!  The
literature is quite clear that exclusive human milk feeds are one very
meaningful way to prevent chronic and painful ear infections and other
respiratory illness in this population of infants.  Generally, infants with
clefts cannot protect the milk supply.  Mothers must pump after attempts at
breastfeeding, and the milk must be fed supplementally.  There are many ways
to do this, and I support trying them all and finding which way works best
for the individual infant.  I have had mixed success with obturators.  They
don't help much if the cleft is towards the junction of the hard and soft
palates or is a cleft of the soft palate.  If the cleft is fairly large and
forward located, I've seen a few babies benefit from them.  They still
couldn't breastfed well, but they breastfed better than without it.
Breastfeeding for many infants with clefts amounts to mother hand expressing
into their mouths.
B.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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