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If the baby has a complete cleft palate (as is typical with PRS), then
transferring milk from the breast is unlikely. However, the baby may
learn how to press milk from the breast using positive pressure, if
given opportunities to practice. Mom can also use a syringe and tube at
breast to give the baby milk as he sucks. Doing so once or twice a day
would help preserve the baby's breastfeeding skills until after the
cleft is repaired. PRS babies generally feed best in a prone position,
with a little head extension to help open their airway.
Probably the best thing that can be done for moms of cleft affected
infants is help maintaining milk production for the long haul. I usually
encourage moms to over pump initially (to aim for an output of about a
quart (liter) of milk a day by 4 weeks postpartum, so that if
lactoengineering is needed there will be extra milk to do this with.
Also the higher initial calibration seems to help insulate the mom
against the dwindling milk production issue that some long term pumpers
have.
My trick for using the Haberman is to hold the baby semi-prone along my
forearm, with my hand helping support his head in extension. The other
hand holds the feeder. Pace carefully, these little ones have a hard
time getting milk down the right pipe. Tongue motions are usually
abnormal in a cleft-affected infant, because they don't have the normal
boundaries for their tongue movements, and often keep their tongue tip
in the cleft. That's why I like them to have some time at the breast, to
give some normal input to the tongue and stimulate normal movements.
If the baby does not have a cleft, then breastfeeding in a prone
position with the head extended (tipped back) should be tried. The head
extension both increases the contact and mechanical advantage the tiny
mandible has with the breast, as well as opens the airway and helps keep
the tongue from falling back into it. The Haberman can be used in prone
or semiprone if baby needs more support.
Good luck, this is a tough situation.
Catherine Watson Genna, IBCLC NYC
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