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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