Hi I am mainly a lurker who is looking and learning on lactnet whenever I can. 
I am a speech language therapist/IBCLC and has some experience working with
babies with cleft lip and palate and tongue tie. 
Regarding the baby with cleft lip and palate. If the baby has a complete
bilateral cleft of the lip and palate he will not be creating much suction
at all, so 25 - 50 ml from a Haberman is not bad at all, hopefully it is
breastmilk, because small breastmilk feeds can go a long way for these
babies and intake will probably increase over time.  The Haberman soft cup
is a modified cup and the baby needs to drink the milk as for cupfeeding
i.e. no use of suction or compression at all. In my experience it is very
slow and only helpful for very short term use. A baby sucking will transfer
much more milk than one taking milk via cup. 
Another option to look at is the Pigeon cleft lip and palate feeder. Some
babies take to this very well, although I find the flow very fast and few
babies able to manage it early on or the old ever reliable squeeze bottle
with slow flow teat.
You can mail me privately if you have difficulty obtaining any of these.
 
Regarding tongue tie I would just like to say that over the past few years I
have seen several babies and toddlers with tongue tie and I have been able
to facilitate tongue tie division in our hospital where this procedure
continues to be looked at with considerable cynicism. 
I must however say that there is much more to tongue tie than meets the eye
and it is not a clear cut black and white issue. With all respect to Brian's
client who saw a dramatic change after tongue tie division, in my experience
this type of scenario will be highly exceptional. The movements of the
tongue for speech are fine highly co-ordinated movements and most children
will compensate exceptionally well to produce them adequately in the
presence of tongue tie.
The impact of tongue tie will frequently be perhaps less accuracy and
therefore clarity(intelligibility) of speech may be an issue, but at the
same time when evaluated clarity will be well within normal range. In my
(humble) opinion fatigue is a more important issue that is frequently
overlooked, i.e. the child's speech will deteriorate over time and this will
have an effect on their motivation to participate, tell stories etc. This is
hard to measure, so speech may present well within normal range and
therefore therapists and other health care professionals remain skeptical
about the need for tongue tie division. 

As with feeding it is so important to get the whole picture and with the
babies that I have been working with over the past few years there are so
many that feed very well in spite of tongue tie and when there are problems
it is so rare only the tongue tie in isolation and when you release the
tongue tie bingo all is well. So what I am saying is that we all still have
much to learn.
Loraine Hamm
Speech Language Therapist/IBCLC and Lifetime scholar 


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