Hot Topic Blog - Mouth Development & Function

CLEFT LIP AND PALATE: TIPS FOR BREASTFEEDING AND FEEDING

What is cleft lip and palate, what produces these, and how do they affect infant feeding?

Cleft lip and palate are malformations of the face and upper jaw, and the presentation can be varied. These can range from an incomplete cleft lip condition to the most complete presentation (affecting the nasal floor, alveolus, as well as the hard and soft palates).

Such malformations are produced by an embryological defect during the formation of the face and upper jaw resulting from a disruption in fetal development between the 4th and 12th weeks of gestation. These disruptions can impact the floor of the nostrils, the upper lip, the pre-maxilla, as well as the hard and soft palates.

The frequency of occurrence can vary between 1 in 600 and 1 in 1200 births depending on the racial group and geographical area where people live.The oropharyngeal area is of greatest concern because these mechanisms affect respiration, swallowing, articulation, hearing, and voice.

Breastfeeding a baby is in itself an act of love. It creates a unique mother-child bond from which father-child and other family-child ties will be created. Adequate feeding allows the baby to grow and develop. It prepares the bucco-facial musculature by activating the tongue and other muscles of the mouth for learning speech, as well as other oral sensory-motor skills such as sucking, swallowing, and chewing.

Feeding before birth through the umbilical cord creates a mother-child bond which extends after birth via the act of feeding at the maternal breast. Not all mothers achieve this type of feeding for various reasons, but breastfeeding greatly benefits the baby. It improves the baby’s immunological defenses and supports the mother-child affective-communicative connection. Mothers may find breastfeeding a baby with a cleft more challenging than feeding a baby without a cleft, but it is not impossible.

What should a baby with a cleft achieve to feed?

- Suction to favor the action of oral muscles, strengthen the maternal bond, attain calming by the sucking itself, and ensure nutrients.

-Breastfeeding should always be tried first due to the elasticity of the breast which adapts to the fissure allowing suction/sucking.

-When breast feeding is not possible, bottle feeding is often done using formula milk while monitoring the baby's weight gain to see if it is effective and adequate.

Which difficulties can you have in feeding a baby with cleft?

In clefts of the lip, suctioning/sucking can be difficult. Therefore, a hypoallergenic tape may be placed to help close the orbicular girdle (until surgical repair).

In cases of cleft palate, communication between the oral cavity and the nasal cavity is open and the uvula does not seal the pharynx, so milk can go into the nasal area. Additionally, regurgitation or reflux can go into the nasal cavity.

How to help the baby with a cleft feed?

-Position the baby at a 45-degree angle (a semi-erect position).

-Center the baby's lips on the mother's nipple by bringing the centered nipple into his mouth. If necessary, keep a finger in the fissure to help make the closure and facilitate suction/sucking.

-The use of feeding bottles or special teats in cases of cleft palate requires special techniques to achieve feeding.

- Feeding bottles and pacifiers should be carefully chosen. Bottle nipples should regulate the output of milk to avoid choking and facilitate improved sucking as the baby grows. The nipple outlet diameter may be 3mm at the beginning, then 2mm, until reaching the common teat of 1 drop per second. This can be found in special bottles sold commercially which can offer many benefits.

-The time it takes the baby to feed should not exceed 30 minutes, so the baby does not become exhausted. Take into account and control the suction. If the baby makes noise, swallows air, etc. work with the feeding and swallowing specialist.

-The usual feeding of a baby is every 2 to 3 hours at first up to 12 times per day. As the baby ages, this decreases to 8 times per day.

At birth, a shutter plate (orthesis) may be placed. Its function is to improve breast or bottle feeding, position the tongue, separate the nasal and oral cavities, stimulate the palatal veil, avoid regurgitation, and help to direct the maxillary fragments into position. It is replaced every 15 days over the first 6 months and then every 30 days until the surgical closure begins.

Solid foods begin to be given at 6 months with light consistencies using a flat spoon. The textures, flavors, and consistencies should vary as the baby is finding a taste for food.

According to Dr Benún from Argentina, a baby can be fed 2 to 3 hours after lip surgery, having passed the fluid tolerance test and keeping the wound clean and dry. In the case of palatal surgery, milk intake is suspended for 48 hours, and the baby is given water, tea with sugar, soy milk, apple juice, broths, gelatin, and/or water ice using a glass or spoon. A bottle is not used for 48 hours.

About Dr. Adriana Nora Habbaby (adrianahabbaby@gmail.com)

- PhD in Speech, Language, and Audiology Pathology. Graduated from the Faculty of Medicine of the University of Salvador and PhD from UMSA (University of the Argentine Social Museum). Bs As. Argentina

-Specializes in speech, language, audiology, and stomatology at the Hospital Cosme Argerich.de Buenos Aires. Argentina. Otorhinolaryngology Unit

-Professorship participation in the Chair of Vocal Pathology I, Speech Therapy career at the UBA and in the Department of Teaching and Research at Cosme Argerich Hospital

-Professor of courses at distance and presence C.I.Fo.- Training and Exchange in Speech-Language Pathology and Audiology for 10 years

-In 2012, she completed her rotation at the Lakeshore Professional Voice Center and School of Medicine, Wayne State University, Detroit, Michigan, USA

-More than 28 years of experience working with speech, stomatology, language, and audiology pathologies in babies, children, and adults

-Author of the books: Enfoque integral del niño con fisura labio palatina, Edit. Médica Panamericana. Bs As. (2000); Arg. Disfonias del niño y del adolescente. Edit. Akadia (1° 2006)-2° editc. 2017. Bs As. Arg; Co-author: Clínica Fonoaudiológica. Edit. Univer. Rosario. Arg. (2010)

-Author and co-author of research papers and books on topics related to the voice, speech, and stomatology problems for Argentina-México y Brazil