Cleft Palate

[pagandeva2000, LPN]

I am an LPN that occasionally does home care. I was offered a position that paid pretty well to care for a three year old infant with cleft palate. I declined the position because I know that there are feeding issues with them, and it seemed as though the child was just discharged from the hospital. I didn't feel that it would be safe for the infant to just read a crash course in feeding them, and my nerves probably couldn't handle an (understandably) anxious mother when I am unsure for myself.

How do you feed these infants? I think I remember reading that their heads have to be propped up a bit more and special bottles. I also read that you should let them suck a bit at a time and expect for this to be a longer session of feeding. Thanks!

[DutchgirlRN, ASN, RN]

I worked OB for 12 years and never saw a baby with a cleft palate. I have also worked pediatric homecare and the one thing I learned is that you can never judge a case until you actually go to the home to see the situation for yourself. There are all levels of severity with cleft palate. It is very possible that the patient has a Mickey G-tube and doesn't take anything by mouth. Ask questions.

[pagandeva2000, LPN]

I worked OB for 12 years and never saw a baby with a cleft palate. I have also worked pediatric homecare and the one thing I learned is that you can never judge a case until you actually go to the home to see the situation for yourself. There are all levels of severity with cleft palate. It is very possible that the patient has a Mickey G-tube and doesn't take anything by mouth. Ask questions.

Thanks. Like I said, I decided not to take the case, because they offered it last minute (and I already have a full time job and work for other agencies), having only a few hours to get there for an overnight shift. I usually go to visit the case before I accept to see if I can handle it myself. Also, the RN at that particular agency was not available, it was one of the non-nursing staff that called me. I would have been tired, not having much time to read about it, or make clear and safe judgements at such short notice.

[elizabells, BSN, RN]

In my NICU we use a Haberman feeder. It has a long nipple on which you can vary the flow rate. The baby doesn't really suck on it, you squeeze the bottle along with the baby's swallowing rythm (or attempts at sucking). It can be a little tricky; I'm not great at it myself.

[morte, LPN, LVN]

was this a 3 YEAR old, or a three week old?. a three year old with an unreconstructed cleft palate would seem unklikely , unless he/she had other issues....this malformation has occurred in my family, both my younger brother and his frst born.....i can remember that my mother fed my brother with a glass ascepto syringe with the end of a red rubber cath put on the end.....the tp was placed in the bucal pocket, and small amount of feeding expressed at a time...the nephew...i think they had plastic syringes,, and he was much bigger as an infant and had his surgery much younger....

[EricJRN, MSN, RN]

Pic of the Haberman Feeder:

[33-weeker]

There are Haberman feeders like the ones pictured and Cleft Palate Nursers that are big soft plastic bottles with longer nipples that you squeeze gently as the baby sucks. I've even had luck with a Cleft Palate Nurser using a Similac Orthodontic Nipple instead of the long nipple that comes with it. It depends on the baby and how severe the cleft is.

Babies are sometimes fitted with prostheses that fit in the top of their mouths to form an artificial palate until surgery can be done. If the palate is not too involved, sometimes they can breastfeed better than bottlefeed beacuse the breast will mold to fill the gaps and fit their anatomy better, allowing them to form a seal better.

Bottom line - every baby is different. If it's just the lip involved, they tend to do better, but the more open the palate, the worse they feed as a rule. The can't form a seal and suck, they can just 'bite' the nipple more or less and swallow.

You sit them upright as much as possible, take it slow and stop for a bit take if they start to get choked. Try angling the nipple to one side or the other and see if that helps - sometimes it can. They gulp more air than other babies, so burp them frequently.

You can get them fed, it just takes more time. The skill you need most to feed these babies is patience.