*Please note* - The following guidelines have been developed by medical professionals and experienced parents. However, it is NOT intended to replace your doctor's advice. If your child has not eaten in 24 hours, contact your local hospital immediately.
Feeding an Infant with an Open Cleft Palate
· Hold the baby in an upright position. This helps to keep milk from coming out of the nose.
· Each feeding should take 30 minutes. Do not allow the baby to go longer than 30 minutes as more calories will be burned than gained.
· You will know your baby is getting enough if they have 6-8 wet diapers in a 24 hour period.
· With all nipple types, wet the nipple before inserting in baby’s mouth. The exposed sinus tissue is very fragile and can easily tear on a dry nipple.
· Burp the baby often.
· Place a burp cloth directly underneath baby’s chin before feeding. Milk will likely come out the nose and mouth during feeding.
· Milk that flows over the tongue is more likely to be pushed into the nasal cavity by the tongue, causing the baby to choke and cough. Directing the flow of milk along the inside of baby’s cheek can be much easier for baby to swallow.
Ross (Haberman) Nipple - Can be used on any standard size bottle, Mead-Johnson bottles are recommended. The Ross should be used for premature and small babies, whose mouths are too small to accommodate a Mead Johnson or Pigeon nipple. Squeeze bottle gently, running a small amount of milk along the baby’s cheek and to the back of the throat. A slow, rhythmic pattern of pulsing milk will allow baby to establish a swallow pattern. This method can introduce quite a lot if air. Make sure to burp the baby frequently. Hand wash only. Dishwashing can degrade the rubber over time. When degraded, the straw portion can break off in baby’s mouth, posing a choking hazard.
Pigeon Nipple – Can be placed on any standard size bottle. Pigeon nipples are easiest to use on a squeezable bottle, like the Mead-Johnson. The nipple is hard on one side, soft on the other. The hard side serves as a replacement palate. The tongue pushing up on the soft side will squeeze the milk out. Insert the nipple into the bottle ring. Confirm that the Y cut and air vent open freely. Firmly push the valve into the base of the nipple. Confirm that the air vent is not caught or held open by the valve. Screw nipple assembly onto the bottle, tight enough it will not leak, loose enough that the air valve is not compressed. This may take some practice. Turn the bottle upside-down (nipple pointing to the floor,) squeeze nipple and release. This should draw some milk into the nipple. You may need to repeat this 2 or 3 times until the nipple is about ¾ full. Wet the nipple. The bottle is now ready to use. Place nipple far in baby’s mouth so that his lips almost reach the ring. The hard side and air vent must be placed up, closest to baby’s nose (notch to nose). Hand wash the Pigeon nipple, valve and the Mead Johnson bottles with warm soapy water and allow to air dry. The plastic is soft and wears out quickly.
The Pigeon nipple can be more complicated to set up and use at first, but it is typically easier for baby to drink from. Unlike the Ross or Haeberman, the Pigeon nipple allows babies to establish their own swallow rhythm.
· Nipple collapses – The air vent is obstructed. Loosen the bottle ring. When tightened correctly, you should be able to hear air bubbles coming into the bottle as baby feeds.
· Milk is leaking out around the bottle ring – Bottle ring is too loose, or air valve may be pinched open.
· Nipple isn’t filling – Squeeze gently after each swallow. This happens as the nipple gets older. Hard water build up on the valve is usually the cause. Soak in vinegar for 20 minutes and rinse thoroughly to remove.
· Baby is fussing an unusual amount – Milk flow may be too slow. (This is common as babies get a bit older) You can cut the Y opening slightly larger. Take note: if the opening is too large, the system will not work.