Introduction
Children born with a cleft palate with or without a cleft lip, cannot breastfeed. This is due to their inability to generate the pressure required to suck milk from the nipple. Breastfeeding or using a traditional bottle system with a cleft palate and palate child can result in poor weight gain and failure to thrive. It may be possible to breastfeed a cleft palate baby if the cleft is small and narrow. The breast should be held deep enough into the palate area for the infant to gain a strong hold and work the breast with his or her tongue. A baby with a cleft palate will require assistance achieving a good latch-on.
What Is a Cleft Palate and Lip?
When there is a cleft lip (CL), the lip is not contiguous, and when there is a cleft palate (CP), there is communication between the oral and nasal cavities. The severity of a cleft can range from a simple notch in the top lip to a full hole in the lip that extends into the nasal cavity floor and includes the alveolus to the incisive foramen. Similarly, CP can affect only the soft palate or the hard and soft palates. If there are subtle or no corresponding clinical signs or symptoms, the alveolus remains intact in CP.
What Is the Normal Physiology of Breastfeeding?
Breastfeeding is defined as the direct placement of a baby to the breast for feeding. In contrast, breastmilk feeding is the delivery of breastmilk to a baby via a bottle, cup, spoon, or any other means other than the breast. To successfully breastfeed, babies use both suction and compression. Suction generation is required for attachment to the breast, maintaining a stable feeding position, and milk extraction in conjunction with the let-down reflex.
When a baby feeds, their lips normally flange firmly against the areola, sealing the oral cavity anteriorly. The soft palate rises up and back to contact with the pharyngeal walls and posteriorly seals the oral cavity. The oral cavity expands as the tongue and jaw drop during sucking, and suction is generated, drawing milk from the breast. Compression occurs when the baby presses the breast between the tongue and jaw.
How Is Breastfeeding Affected Due to Cleft Lip and Palate?
During breastfeeding, suction and compression aid in milk transfer delivery. The amount of oral pressure generated during feeding is related to the size or type of cleft and the baby's maturity. As a result, babies with CL are more likely to breastfeed than those with CP and cleft lip and palate (CLP). In addition, some babies with small soft palate clefts generate suction, but others with larger soft or hard palate clefts may not generate suction.
What Are the Difficulties of Babies With Cleft Lip and Palate Face During Breastfeeding?
As the oral cavity of babies with cleft lip and palate cannot adequately separate from the nasal cavity during feeding, babies with CP or CLP have difficulty creating suction. Negative consequences for these infants may include the following:
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Fatigue during breastfeeding.
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Difficulty in feeding.
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Inadequate feeding.
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Negative pressure while feeding.
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Extended feeding times.
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Impaired growth and nutrition.
What Are the Recommendations for Breastfeeding Babies With Cleft Lip and Palate?
The following recommendations are made for breastfeeding babies with cleft lip and palate:
Breastmilk Feeding
Encourage mothers to provide the protective benefits of breastmilk. Breastfeeding appears to protect against otitis media. Therefore, breastmilk feeding (via cup, spoon, bottle, etc.) should be encouraged over artificial milk feeding. In addition, feeding plates can also be used to create a seal between nasal and oral cavities in cleft palate patients to prevent regurgitation of milk. These plates can be used after consulting the dentist.
Counseling Mothers
At the same time, mothers should be counseled on their chances of success with breastfeeding. Where direct breastfeeding is unlikely to be the sole feeding method, the need for breastmilk feeding should be encouraged, and possible delayed breastfeeding transitions should be discussed when appropriate.
Size and Location of Baby’s Cleft Lip or Palate
Babies with cleft palate should be evaluated individually for breastfeeding. It is essential to consider the size and location of the baby's CP, the mother's wishes, and previous breastfeeding experience. There is some evidence that infants with CL can generate suction and can often breastfeed successfully. However, most infants with CP or CLP have trouble producing suction and have inefficient sucking patterns compared to normal infants.
Early Instruction on Feeding Challenges
As with regular breastfeeding, knowledgeable support is essential. Mothers who want to breastfeed should have immediate access to a lactation specialist who can help with positioning, milk supply management, and expressing milk for supplemental feeds. In addition, several studies have suggested having access to a health professional who specializes in CL/P, such as a clinical nurse specialist, during the newborn or infant period for specialized advice on feeding a baby with CP, as well as referrals to appropriate services, is necessary and beneficial. In addition to routine referral to breastfeeding support groups, families may benefit from peer support around breastmilk feeding or breastfeeding found through associations.
Supplemental Feeding
It is critical to monitor a baby's hydration and weight gain while establishing a feeding method. Supplemental feeding should be implemented or increased if it is insufficient. For adequate growth and nutrition, infants with cleft lip and palate may require supplemental feeds.
What Are the Different Breastfeeding Positions for Babies With Cleft Lip and Palate?
Breastfeeding position changes may improve the efficiency and effectiveness of breastfeeding. Various positioning recommendations include:
For Infants With Cleft Lips
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The infant should be held in a cross-cradle position at the right breast and a football or twin-style position at the left breast; for example, an infant with a right CL may feed more efficiently in a cross-cradle position at the right breast and a football or twin style position at the left breast.
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To reduce the width of the cleft and increase closure around the nipple, the mother may occlude the CL with her thumb or finger and support the infant's cheeks.
For Infants With Bilateral Cleft Lip
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A face-on straddle position may be more effective than other breastfeeding positions for bilateral CL.
For Infants With Cleft Plate or Cleft Lip and Palate
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Position them semi-upright to reduce nasal regurgitation and breastmilk reflux into the Eustachian tubes.
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A football hold or twin positions the infant's body alongside the mother rather than across her lap and the infant's shoulders higher than their body. It could be more effective than a cross-cradle position.
Conclusion
Ear infections are more common in babies with cleft lip or cleft palate, and breast milk helps protect against these infections. In addition, breast milk contains antibodies from the mother that are passed on to the baby. Choking and milk leaking from the nose are possibilities in infants with cleft lip and palate during breastfeeding. Because breast milk is a natural body fluid, it is less irritating to the mucous membranes than formula. Breastfeeding helps babies with cleft lip and palate strengthen their face and mouth muscles, resulting in more normal facial formation. However, if the cleft is larger and the infant is having problems sucking the milk from the breast, it is recommended to shift to supplemental feeding and seek advice from a lactation counselor.
