For Parents > Feeding Your Child

Guidelines for Feeding and Care
of the Cleft Lip/Palate Infant

Proper feeding is basically the same as with any other infant. Although feedings may be longer and more frequent, it is important to learn as much as you can about the cleft condition so that you can become a relaxed parent. You will become more at ease with your child when you gain the necessary self-confidence that what you have been taught is correct.

1. Breast Feeding: It is possible for many mothers to breast feed a newborn with a cleft lip or palate. You should discuss the advantages and drawbacks of breast feeding with your doctor. If you decide not to breast feed, you can feed the same infant formulas that are used for other infants.
   
2. Vitamins: As your doctor advises you.
   
3. Frequency of Feeding:
   1. Every 3-4 hours
   2. Some may feed on a "demand" schedule.
   3. To avoid tiring your baby, no feeding should last longer than 45 minutes. Ideally, feeding should be completed within 15-30 minutes.
   4. Place nipple against the cheek, toward the back of the tongue, or any place in the mouth below the hard palate. The nipple should never be put into the cleft or directed down the throat.
   5. Infant will attempt to "chew" milk out by gumming the nipple. This is good!
   6. Feed as much as the baby can handle; feed slowly, and remember to burp the child frequently when the baby slows down and cannot be encouraged to feed more. Gently pat the baby's back to expel swallowed air which may be causing belly pain.
      
   7. If choking occurs: Don't panic! There's no need for alarm.
      1. Stop feeding and place infant in sitting position.
      2. Wipe milk from nose and start feeding all over again. This time feed more slowly and make sure the milk does not strike the back of the throat. If choking persists, replace the nipple with one that has a smaller opening, preferably a cross-cut fissure (Mead Johnson). Reduce the amount of milk entering the mouth so that the child can alternate between breathing and swallowing.
   8. Baby may fall asleep before finishing the required amount of formula. To awaken, move nipple between the lips and against the cheek. Sometimes, it is best to stop feeding at this time since the baby may not be hungry. The baby may consume more formula at one feeding than at another, just like any other child.
4. Bottle Feeding: This is recommended over spoon feeding. A squeezable plastic bottle with a cross-cut nipple opening or one with a very fine hole that opens when the plastic bottle or plastic bag is compressed, as in a Playtex Nurser, is best. If a bottle is used for a thicker fluid it may be necessary to make the nipple hole larger than when feeding milk or its substitute.
5. Baby's Position: Baby should be held at a 45° angle. Cradle your baby in your arm. Be tender, relaxed and patient.
6. Feeding Aid ("Obturator"): The space in the palate may not need to be covered with an obturator (plastic plate) in order to achieve good feeding. Most cleft palate clinics do not recommend its use, unless the child has severe feeding problems.
7. Cleaning the Mouth and Adjoining Cleft Areas After Feeding: All areas around the cleft should be kept clean. If you do need to rub the mouth area, do not be overly concerned about hurting the lips and gums adjacent to the cleft space. The cleft is not a wound and it is not tender to the touch. Food, if left to accumulate, will mix with mucous secretions from the mouth and nose to form a hard crust. This crust can cause an infection to the lip area which then may become tender.
   1. Materials often used to clean the areas adjacent to the cleft:
      1. cotton
      2. cotton-swab
      3. gauze
      4. wash cloth
   2. Solutions used in cleaning:
      1. plain water
      2. sterile (boiled) water
      3. water with hydrogen peroxide (half/half)
   3. If lip area becomes crusty: Do not remove crusts without softening with:
      1. baby oil
      2. mineral oil
   4. If the cleft lip becomes slightly infected:
      1. Wash with antiseptic soap, or regular soap, and water
      2. Add mild antiseptic to the water, such as hydrogen peroxide
      3. Apply or wash with a fungicide solution (which prevents fungal infection)
      4. If the infection persists call your physician
8. Review
   1. Don't be afraid to touch all areas around the cleft with your finger.
   2. Keep these areas clean after all feedings.
   3. Soften all crusts which may form before trying to remove them.
   4. Keep area free from fungal infections.

The Older Child

1. Feeding of Solids (Strained and Chopped Foods)
   1. When: Start at the same time as you would with a non-cleft infant.
   2. How: Dilute strained foods, if necessary, and feed with a spoon. Most physicians and nurses do not recommend feeding these foods by bottle. Chopped foods, when given toward the end of the first year, should be mashed first.
   3. Acid and spicy foods: These should be avoided since they may irritate, especially if the cleft in the palate is still open. The linings in the nose are more sensative to this kind of food.
   4. Other foods to be avoided:
      1. nuts
      2. peanut butter
      3. cooked cheese dishes
      4. leafy vegetables
      5. peelings on fruits
      6. creamed dishes.

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