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Eating with a Cleft

“A cleft lip and/or palate is one of the most common craniofacial malformations, occurring worldwide” (de Vares et al., 2023). Clefting of the mouth interferes with the success of a child's eating, impacting the ability to seal the nipple during breastfeeding or not having the strength to suck enough milk for nutrition (Robin et al., 2006). A cleft is when there is a separation of the mouth that is usually joined (Morris & Klein, 2000). A separation can be anywhere in the mouth, running from the lips to the nasal cavity. The most common clefts that are seen are one-sided clefts where one side is separated, or if both sides are affected, the left side is usually more affected. Additionally, clefts are more common in males than females. Children with a cleft palate or cleft lip tend to demonstrate a slower growth rate due to the increase difficulty to efficiently eat.


Both the lips and palate are important for successful eating, as the lips create a seal for incoming liquids or foods from spilling, and the palate creates a boundary and directs the food and liquid to the throat down to the stomach. Since clefts can interfere with a child’s success in eating, surgery is an option in the first months after birth. If surgery is not done, there are several alternatives to help create a pleasant experience when it comes to eating and feeding.


Challenges:

  • Lengthy feeding times

  • Frequent feeds

  • Nasal regurgitation

  • Vomiting from excessive air intake

  • Colic

  • Insufficient nutritional intake

  • Weight gain

  • Coughing and choking during feedings

  • Maintaining oral hygiene

Helping Children With a Cleft:

  • Use your fingers to close off where the cleft is

  • Position baby sideways like holding a football for a secured breastfeeding position

  • Slowly introduce small amounts of foods

  • Allow the baby to initiate incoming food to their mouth

  • Modify seating position

  • Implement a teeth brushing routine

  • Using the right bottle

    • Cleft Lip/Palate Nurser by Mead Johnson

      • Provide a squeeze to the bottle when your baby is sucking

      • When your baby pauses, you pause

    • SpecialNeeds Feeder

      • Keeps milk in the nipple of the bottle where suction is not required

    • Dr. Brown’s Specialty Feeding System with One-Way Valve

      • Keeps milk in the nipple of the bottle where suction is not required

      • The baby controls the flow of liquid

    • Pigeon feeder

      • Fits on any standard bottle

      • Keeps milk in the nipple of the bottle where suction is not required

      • The baby controls the flow of liquid

      • Has a soft and hard side, the soft side hitting the baby’s tongue

      • A small notch on the nipple acts as an air vent. This notch should go under the baby’s nose.

      • Tightening the nipple, slows the flow of liquid


References

Coffee, G. (2021, October). Cleft lip and cleft palate feeding. Cincinnati Childrens.

https://www.cincinnatichildrens.org/health/c/cleft-feeding

de Vries, I. A. C., Guillaume, C. H. A. L., Penris, W. M., Eligh, A. M., Eijkemans, R. M. J. C.,

Kon, M., Breugem, C. C., & van Dijk, M. W. G. (2023). The relation between clinically

diagnosed and parent-reported feeding difficulties in children with and without clefts.

European Journal of Pediatrics, 182(5), 2197–2204. https://doi.org/10.1007

/s00431-023-04852-1

Helping Hand. (2019, August). Cleft palate: Feeding your baby. Nationwide Children’s

Hospital. https://www.nationwidechildrens.org/family-resources-education/health-

wellness-and-safety-resources/helping-hands/cleft-palate-feeding-your-baby

Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive

resource for mealtime development. Pro-ed International Publisher.

Patient and family education: Cleft feeding instructions. Seattle Children’s Hospital. (n.d.).

https://www.seattlechildrens.org/clinics/craniofacial/patient-family-resources/cleft-

feeding-instructions/

Penny, C., McGuire, C., & Bezuhly, M. (2022). A systematic review of feeding interventions for

infants with cleft palate. The Cleft Palate-Craniofacial Journal: Official Publication of the

American Cleft Palate-Craniofacial Association, 59(12), 1527–1536. https://doi.org

/10.1177/10556656211051216

Robin, N. H., Baty, H., Franklin, J., Guyton, F. C., Mann, J., Woolley, A. L., Waite, P. D., &

Grant, J. (2006). The multidisciplinary evaluation and management of cleft lip and

palate. Southern Medical Journal, 99(10), 1111–1120. https://doi.org/10.1097

01.smj.0000209093.78617.3a

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