Question

As the nurse, you are providing care for an infant who has cleft palate; based on the understanding of cleft palate, what (a) position would be most favorable during feeding (b) what type of bottle/nipple would be preferred, and (c) what would you advise the new parents in regards to feeding (can discuss during the feeding and post-feeding) (answer a, b, and c separately).

Answer 1

(a) The appropriate method to feed infant with cleft palate is by 'Dancer hand position'. Slide the hand under the breast forward, that is supporting the breast with three fingers rather than four form a U- shape with the thumb and forefinger to cradle the baby's chin, this helps the baby to press the nipple and areola between the gums.it helps to prevent choking and the milk from flowing back into the respiratory passage .

(b) There are several different nipples available for babies with cleft palate. An effective nipple usually is soft and has a cross cut or several extra holes.

The Haberman feeder is a feeding unit designed especially for babies with cleft palates. This bottle has a specially designed nipple that keeps liquid in the nipple once the nipple has been sucked. The liquid does not flow back out, as in most nipples. It has a slice -cut hole that responds to the typical chewing action of the child.

The Mead Johnson cleft palate Nurser set is another feeding unit consist of a cross-cut soft nipple used in infants with cleft palate

(c)

• Keep your baby upright when feeding. Gravity will help keep the milk out of the nose.
• Aim the nipple toward the part of the palate that does not have the cleft.
• Your baby should develop a consistent sucking and swallowing pattern .watch for one to three sucks followed by a swallow and then a breath.
• Burp your baby often every half to one ounce.
• Initially feed your baby every 2 to 3 hours, day and night , for a total of 8 to 10 feeding in a 24 hour period.
• Feeding should last no more than 30 minutes.
• Watch for weight gain in babies regularly.