Monday, September 17, 2012

Breastfeeding and cleft lip

Every once in awhile, a Mummie comes to me about a topic I have not come across. This gives me the chance to do some research and allows me to expand my knowledge in breastfeeding. I LOVE most of those chances... but last week one of my Mumies (one of my readers) came to me with a sad heart. She was given some unexpected news regarding her future Nummie Lover and needed to know as much as possible about her future breastfeeding journey. This Mummie found out her first Nummie Lover has a cleft lip and a cleft pallet with a possibility of a chromosome abnormality. Now, the chromosome abnormality has yet to determined... but the cleft has been. Baby L and his Mummie are in for a breastfeeding journey that they did not expect. BUT they can still embark (and ROCK) their breastfeeding journey.  

Cleft Lip and Cleft Pallet is defined as this: Cleft lip (cheiloschisis) and cleft palate (palatoschisis), which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening—a gap. It is the non-fusion of the body's natural structures that form before birth. Approximately 1 in 700 children born have a cleft lip and/or a cleft palate.

What is certain, with Cleft Lip and Palate, is that a closeness/bond, between Mummie and Nummie Lover, is super important. As with any other breastfeeding journey, skin to skin contact and breastfeeding helps to build the bond between the two. A Mummie/Nummie Lover bond can help you overcome many obstacles. Not all breastfeeding journeys are easy, and most have struggles. A Mummie and Nummie Lover who are battling Cleft Lip/Pallet will for sure find their own speedbumps... But there are tips to help ease the bumpy road and EDUCATED specialists how are there to help.

I have come across some information that I hope will help prepare all families who are walking the Cleft Lip/Pallet journey.

It is well known that breastmilk is ideal for MOST babies... but with babies with Cleft Lip/Pallet it goes beyond the nutritional value. The soft tissue of the breast is ideal for these babies. The flexibility of the breast allows it to be molded to compensate for abnormalities of the baby's lip or mouth. The Nummie Lover has more control over the flow of breastmilk and the position of the breast in his/her mouth. Early practice helps baby imprint on the breast, which is important for both Mummie and Nummie Lover.

Although choking due to milk leakage into the nose is a common problem when there is an opening in the soft or hard palate, human milk is a natural bodily fluid that is not irritating to the mucous membranes. Therefore, breastmilk is the optimal choice for feeding a cleft lip or palate baby.

A baby needs to suck for comfort as well as nourishment. Breastfeeding allows a baby to spend time at the breast sucking for comfort as well as for feeding... which will give the baby a chance to "get to know" your breasts and helps you get to know how they eat as well as building your breastmilk supply.

You can also feed via spoon feeding or finger feeding, in the early days your Nummie Lover's tummy is only the size of a marble and growing slowly the following days. Not much milk is needed to fill a tiny tummy (check the photo below.)

Studies have shown that babies with Cleft Lip/Pallet are prone to Otitis Media (or middle ear infections.) Breastmilk has been proven to reduce the risk for all forms of ear infections... breastmilk does not PREVENT ear infections but it does lower the risks greatly. Also there is speculative information regarding possible benefits of breastfeeding versus bottle feeding on the development of the oral cavity, as the breast tissue is softer than a bottle nipple, the baby's mouth can conform properly to a breast.

As with other breastfeeding journeys, most of the same "tricks" apply.

Monitoring is the best way to determine proper eating. Checking how many wet diaper and dirty diapers daily is a GREAT way to determine this. describes this counting process: "In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two…) Once mom’s milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. In the early days, baby typically has one dirty (poopy) diaper for each day of life (1 on day one, 2 on day two…). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often–this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy."

Education and support are play major roles in breastfeeding. Make sure all of your doctors, nurses and hospital staff know that you want to breastfeed ASAP and you want to continue to do so. Make sure they all know that you do not wish for your baby to be bottle fed without your consent. Also, ask to see a lactation consultant right away... and if you are not happy with the LC you were given, ask for another one! Not all LCs are the same. This is YOUR journey, YOUR baby... make sure you surround yourself with supportive and KNOWLEDGEABLE staff.

Position is EVERYTHING!!!!!!!! Your LC or doctor should work with you and your Nummie Lover to help establish the proper  positioning for your baby. Here are some ideas for babies with Cleft Lip:

The infant should be held so that the cleft lip is orientated toward the top of the breast , (e.g., an infant with a right Cleft Lip may feed more efficiently in a "Madonna" position at the right breast and a "football/twin style" position at the left breast)

The mother may occlude the Cleft Lip with her thumb or finger and/or support the infant's cheeks to decrease the width of the cleft and increase closure around the nipple
For bilateral Cleft lip, a "face-on" straddle position may be more effective than other breastfeeding positions.

For babies with Cleft Lip and Pallet or Cleft Pallet:

Positioning should be semi-upright to reduce nasal regurgitation, and reflux of breastmilk into the Eustachian tubes.

A "football hold"/twin position (body of infant directed away from the mother, rather than across the mother's lap, and with the infants shoulders higher than its body) may be more effective than a traditional Madonna position.

For infants with a Cleft Pallet it may also be useful to position the breast toward the "greater segment"—the side of the palate which has the most intact bone. This may facilitate better compression and stop the nipple being pushed into the cleft site.
Some experts suggest supporting the infant's chin to stabilize the jaw during sucking and/or supporting the breast so that it remains in the infant's mouth.

If the cleft is large, some experts suggest that the breast be tipped downward to stop the nipple being pushed into the cleft.

Mothers may need to manually express breastmilk into the baby's mouth to compensate for absent suction and compression and to stimulate the letdown reflex.

Another great tidbit is that it is recommended that breastfeeding continue right after a lip repair is done. Breastmilk has been shown to reduce pain levels and the close bonding moments of skin to skin will help with healing as well.

I came across a GREAT resource for medical field workers regarding Cleft Lip/ Pallet.. it might be a bit hard to follow... but the information in there is WORTH reading and sharing with your doctors.

Breastfeeding with Cleft Lip and Pallet has been done by so many, but I was able to find some personal stories. La Leche League shared a personal story on their website and a Mummie shared her Cleft Lip breastfeeding journey story on Milk for Thought.

No one can tell you for sure if your breastfeeding journey will be easy, and the odds are breastfeeding a Nummie Lover with cleft lip/pallet will have some major road blocks.... but with the correct help, education and support you can always find a detour.


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