Feeding problems affecting children with a unilateral cleft lip, alveolus and palate depend on the size of the cleft as well as on other factors. Since there is a connection between the mouth and the nasal cavity, children with a bilateral cleft lip, alveolus and palate cannot vacuum suck (create low pressure in the mouth) which is normally necessary to suck effectively.
This can result in
- quickly getting tired when drinking
- regurgitating food through the nose
- not drinking enough
- drinking very slowly
- swallowing too much air
Breastfeeding or bottle feeding
Breastfeeding is not always possible, but it is certainly worth trying. Your speech and language therapist, nurse, paediatrician or gynaecologist can advise you about this.
If you bottle feed we recommend using a wide-based three-position teat, for instance a Dodie three-position teat (“second age”). Normal motor development of the mouth is stimulated best by using an ordinary three-position teat, making it easy to vary the speed of feeding by turning the bottle.
If feeding is not successful using this method, it is best to try a Haberman bottle with a special teat. A Haberman bottle is a hard plastic bottle with a membrane and teat. Due to the special valve structure you can squeeze the teat along with the baby’s drinking rhythm. This means the baby does not have to suck hard and feeding is quicker and easier.
- Try changing posture: keep your baby as upright as possible when feeding, with the head inclined slightly forwards. This prevents regurgitation through the nose and swallowing too much air.
- Try putting the teat in the mouth in different positions.
- Try an ordinary teat – because it stimulates oral motor function best – and try changing the size of the hole or cutting a cross in the end of the teat: the milk will then spray out of the teat and spread over the whole tongue. An older teat may be the solution to sucking problems.
NB: the milk must not flood into the mouth! It is important that the baby should suck actively
- If your baby chokes this is a sign that the hole in the teat is too large. Try a different teat with a smaller hole. Sometimes choking may be remedied by trying a different feeding position. If necessary feed can be thickened slightly.
- Regurgitating milk or food through the nose is not serious, but it is annoying for the baby. Clean the nose with physiological solution after feeding.
- Burp your baby more often when drinking.
- Take your time, but do not allow feeding to last longer than thirty minutes (it is better to do it more often for a shorter time).
- If you continue to have problems with feeding and you are worried about it, do not hesitate to contact your speech and language therapist or your GP or paediatrician.
If your baby is not able to take enough food and fluid using normal feeding methods, it is sometimes necessary to use tube feeding for a time. If this is done discussions will take place with your ENT doctor, paediatrician and speech and language therapist on going back to oral feeding as quickly as possible to develop the feeding reflex and mouth function. As long as your child is being tube fed we recommend using a dummy to satisfy and maintain the sucking reflex.
Changing over to spoon feeding usually does not cause any problems. It is best to follow the advice of Kind en Gezin (“Child and Family” agency) or the GP/paediatrician looking after your child:
- pureed fruit or vegetables from about 4 months
- drinking from a cup from 6 months
- chewing food from about 8 months
Remember that all children have to get used to eating from a spoon and get used to food with different tastes and textures. In particular you should make sure you use a soft spoon and start with just one taste. When you see that your child is getting used to this new way of feeding, you can vary the taste and texture.
When using pureed fruit we advise against using citrus fruits because they can be irritant if the food regurgitates through the nose (reflux through the nose).
After the lip operation you should first give your child a little sugar water. The paediatrician will decide when your child can be fed again. If your child was breastfed before the operation, he/she can be given the breast again after the operation. If you are bottle feeding we would suggest cutting a small cross in the teat so that your child does not have to suck hard.
During the first week after the operation it is best to start with liquid food and then liquid and/or soft food for another three weeks. After about three weeks the wound should be fully healed and you can bottle feed using normal teats again.
On the day after the operation your child will be given some water to drink. He or she will only be given liquid food for one week. Your child must not suck a bottle for four weeks after the operation. He or she can drink milk from a (tipping) cup. The milk can also be thickened with Nutriton, rice powder or koekjesmeel (sweet biscuit flour) and given with a spoon.
After one week of liquid feeding your child can take liquid and soft food for three weeks, for example:
- well-mixed vegetable puree (up to twice a day)
- Petit Gervais, vanilla custard or cheese curds
- Pureed fruit with crumbled cookies
- hard food products (e.g. biscuits or rusks)
- spicy foods
- acid fruits in the puree (e.g. citrus fruits or kiwi)
- fizzy drinks
- dry bread
During the first few days after surgery, feeding is usually not very easy. Your child needs to learn to swallow in a different way and often will not dare to swallow. Usually there are not many problems with swelling or pain. Once your child is eating comfortably again, he/she can leave hospital.
What your child is allowed to eat:
- soft food, mixed and without lumps
- consommé and soup
- (ice-cold) milk
- ice cream
- bread, softened if necessary
- soured milk products like yoghurt and cheese curds.
- fizzy drinks (fizzy pop, sparkling water etc.)
- Ensini: supplementary feed that provides extra protein, vitamins and minerals. Ensini is sold in various flavours (forest fruits, peach/orange).
The mouth of your child should be rinsed out with salty water after every meal.
After coming home your child should continue to eat soft food until the wound has healed properly. This takes about four weeks.