Hello All,
I need some advice/help from all you great minds out there. This is my
first case of a baby with cleft palate (have worked with cleft lip before).
Hx: baby boy born Christmas day, cleft lip apparent but palate was not
identified until 11 days later (when baby brought to clinic because mom
concerned he wasn't eating well) and weight was down more than a lb. (from
8+# to 7#). Mom had previous child with cleft lip who nursed successfully,
so there was no initial concern with this child as all seemed to be going
well in the hospital. I was not called in on this case until the weight
loss was identified. Spent 3 hrs with Mom on 1/5, used all the information
I had to help with positioning and we got the baby to successfully latch
with a good seal. Intake was minimal, but I think baby is so nutritionally
compromised that his suck is too weak. Offered Mom the cup or bottle
technique of supplementing until baby stronger, she chose to use a bottle
with premie nipple (hole cut larger) as that was all we had available. My
boss is getting a Haberman feeder for them to use but it hasn't arrived
yet.
The 2 biggest problems are getting a dentist or orthodontist willing to
evaluate baby for a palatal obturator, she's being told that it's too much
trouble as baby's mouth will be continually changing and the device would
have to be readjusted too often. In other words, take the easy way and just
bottle feed- but this mother really wants to nurse!  The other problem is
her milk supply. She has never been enthusiastic about breast pumps (needed
to use one with first baby who was premie) and just can't let down. I've
given her all the suggestions for relaxation, moist heat and massage, baby
near by, etc, but she is still only getting about 1 oz total with the
Lactina pump. Have her eating oatmeal, but I really don't think volume is
the problem as much as being able to relax using the pump.She had all the
initial signs of good supply, and even though baby's suck is weak, he has
been doing some stimulating. Also, she successfully nursed 3 other babies
so establishing supply should be easier, right? She has been pumping for 2
days now and volume has not increased at all. Any suggestions, or have I
missed something here? I really want to help this Mom, she so much wants to
breastfeed or at least provide breast milk (by the way, we are
supplementing with abm until she can get her supply up). Thanks for any
ideas you guys can throw my way.
Mary A. Banaszewski, RN, IBCLC
From frigid Minnesota
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