Editor’s note: This post is the second in a series that began with “Insights on Feeding and Swallowing Differences for Infants With Cleft Lip and/or Palate.”
As a speech-language pathologist on a cleft palate team, I help offer guidance—before the infant is discharged—on supplemental bottle-feeding for newborns with a cleft palate and/or lip.
As part of this team, I complete a feeding evaluation to determine the adaptive bottle(s) best suited to the infant and provide caregiver training on proper assembly, priming, and use. In my work with infants with cleft lip and/or palate, I also help parents recognize their infant’s feeding cues, nipple placement along the palatal bones (not within the cleft), proper feeding positioning, and handling techniques.
Supplemental feeding assessment with bottle use starts early, prior to discharge from the hospital. Inhibited capacity to transfer milk at breast due to weak or absent oral suction due to the presence of the cleft, feeding endurance and intake volume needs might warrant use of supplemental bottle feeding.
Here is some of what I share.
Here are general positioning and feeding tips. Each baby with cleft palate/lip might need slightly different positioning or approaches.
Monitor for stress cues during feeding and signs of aspiration. Burping
Infants with cleft lip and/or palate demonstrate compensatory swallow patterns potentially contributing to ingestion of more air when feeding. For this reason, more frequent burping—with about every ounce consumed—improves their comfort during and after feeding.
Managing nasal congestion during feeding supports a more comfortable feeding experience. I don’t recommend the use of suction, however, as it can disrupt feeding.
I’ve experienced success with this strategy: move the infant to their side, hips stacked, and keep head and shoulders slightly higher than hips. Watch for the infant to swallow. Then slowly and gently move them onto their other side and watch again for them to swallow. This maneuver helps move the milk from above the palatal shelves. When the infant is then brought back into feeding position the nasal congestion should have cleared. It is important to keep the head/shoulders slightly higher than the hips when doing this maneuver to prevent reflux from traveling into the nasopharynx.
Allyson Goodwyn-Craine, MS, CCC-SLP, BCS-S, has more than 30 years of clinical experience feeding infants with cleft palate and cleft lip and palate. She is an adjunct professor at Portland State University, and also provides outpatient pediatric feeding services and works as part of the NICU rehabilitation team at Sunnyside Medical Center. Goodwyn-Craine is an affiliate of ASHA Special Interest Groups 5, Craniofacial and Velopharyngeal Disorders; and 13, Swallowing and Swallowing Disorders (Dysphagia). [email protected]
Feeding and Swallowing Issues in Infants With Craniofacial Anomalies