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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