The first problem you may encounter may be with the feeding
of your baby. A cleft lip or palate makes it difficult for the baby to get good suction
during breast or bottle-feeding.
Gently squeezing the infant's cheeks together around the nipple may improve oral
suction. In addition the baby's sucking and swallowing reflexes may not work correctly,
and the baby may swallow a lot more air during feeding.
Holding the baby in an upright position can make feeding easier. Burping the baby frequently, after every ounce of formula
is also helpful.
Infants with only a cleft lip or a narrow cleft palate can usually breast-feed. Infants with both cleft lip and cleft palate will usually need to be bottle fed using a crosscut nipple. Specialized squeezable bottles designed for babies with cleft palate and other special feeding
problems are available.
The Mead-Johnson Cleft Palate Nurser
at right includes a long soft nipple with a crosscut hole attached to a
flexible plastic bottle that can be squeezed to increase the flow of liquid
during the baby's sucking.
The Haberman Feeder shown below is designed for babies
with cleft palate and other special feeding problems. The Haberman nipple is
larger and longer than most nipples. The nipple can be squeezed to help the
baby extract the liquid. Air is squeezed out of the nipple before the feeding begins.
Moms should stay alert for signs of dehydration in the baby. If the baby
becomes very sleepy, has no tears when crying, dry lips, dark urine, or no
wet diapers for more than 6 hours moms should call their baby's doctor for
advice. If the baby shows signs of severe dehydration such as sunken eyes
the baby may need to be taken to the emergency room.
Children born with with clefts may have special problems related to
missing, malformed or malpositioned teeth in the area of the cleft.
Evaluation by a dentist who is familiar with the needs of children with a cleft is recommended.
Children with cleft palate are more susceptible to ear infections because of abnormal development of the muscles that control the opening and closing of the Eustachian tubes (or auditory tubes)
The Eustachian tubes connect the middle ear to the throat above the palate. The Eustachian tubes
allow secretions to drain from the middle ear and function to equalize the air pressure on both sides of the eardrum. Repeated ear infections can lead to permanent hearing damage which can effect the normal development of speech.
Ear tubes (also called myringotomy or tympanostomy tubes) may be placed in order to improve drainage from the middle ear.
Children with clefts have an increased risk for
developing problems especially those relating to self concept, peer
relationships, and appearance. Family therapy, support groups, and group
discussions about cleft lip and palate with the child's teachers and
are often helpful.
Cleft palate is associated with the abnormal development of the muscles that
control the soft palate (velum). When the soft palate does not successfully
close off the nose for the oral sounds a hypernasal quality of speech occurs.
Even after palate repair proper closing of the soft palate muscle during speech
may not return entirely to normal.
Children may have difficulty producing the sounds "p, b, d, t, h, k,
g, s, sh, and ch", and speech therapy is often
When Can The Cleft Be Fixed? [19-21]
Cleft lip is usually repaired at 3 months of age. Cleft palate is usually repaired at 9 to 12 months of age.
Revision is sometimes needed at 4 or 5 years of age. Some children with
very large gaps in the hard palate may also need to have the gap filled with
bone when they are 4 to 11 years of age. Additional corrective nasal
surgery may be required when the child's nasal growth is complete.
The many problems encountered during the care of children with orofacial clefts are typically
managed by a Cleft Team that usually includes a pediatrician,a surgeon, a dentist, a speech
therapist, an ear-nose-throat specialist, a psychologist,a
social worker,and a genetic counselor.
Loma Linda University Children's Hospital - Specialty Team Centers
2195 Club Center Drive, Suite G
San Bernardino, CA 92408
The Cleft Palate Foundation
1504 East Franklin Street, Suite 102,
Chapel Hill, NC 27514
March of Dimes
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