Nurse Specialist
Need to contact us?
Get in touch with our admin team
Feeding Support
Your clinical nurse specialist will then arrange to meet you again about six weeks before your baby’s predicted arrival. This is to discuss feeding your baby in more depth as well as answering any further questions you may have.
You may already have planned how you would like to feed your baby, and the CNS will support you in your choice and we will assist in the development of a birth plan respecting your choice.
Your clinical nurse specialist will provide your first supply of feeding equipment. Extra feeding bottles and teats can be purchased from CLAPA. Your CNS will also discuss the feeding support they can offer you once your baby is born.
Feeding Your Baby
A significant part of the cleft nurse specialist’s role is to support you in establishing a feeding regime that gives your baby what he or she needs and works well for you as a family.
Usually, breast or bottle-feeding occurs when the baby’s lips surrounding the nipple or teat and baby’s tongue cups around the breast tissue or teat. Baby’s tongue movement and the ability to close off the nose from the mouth (by lifting the soft palate) causes negative pressure to build up in the baby’s mouth. This is how babies suck and obtain the milk they need.
To feed, new-born babies suck, swallow and breathe in a smooth and coordinated way. Suction is important in both breast and bottle feeding. For babies born with a cleft, the gaps in the lip or palate may make it difficult to create a seal and maintain suction. As a result, they may work harder to try and get the milk from the bottle or breast causing them to become tired and take smaller volumes leading to poor weight gain.
Your baby should have little, if any, difficulty with feeding. Your baby will likely be able to breastfeed normally, and any initial difficulties can usually be resolved by re-positioning the baby. If you choose to bottle feed your baby, you may find it easier to feed using a latex teat as these are softer than silicone and can mould to the shape of the baby’s mouth more easily.
The CNS can offer help and advice about different breastfeeding positions, teats, bottles, and stockists.
Babies born with a wide cleft lip with or without a cleft palate have a gap in the muscles and soft tissue of the roof of the mouth and a gap in the lip and gum.
Although your baby will be able to make sucking movements with their mouth and jaw, babies often have difficulty creating enough pressure to draw enough milk out of the bottle or breast as the cleft can cause an air leak. To help your baby to feed, special bottles and teats will likely be recommended.
Your CNS will assess your baby soon after birth and discuss with you which bottle and teat would be best to use. The bottles we usually recommend are a MAM soft bottle; being soft it allows you to gently squeeze the milk into your baby’s mouth in rhythm with their sucking (assisted feeding), or a Dr Brown infant paced feeding bottle.
The mam bottle is used with a latex orthodontic shaped teat. Teat size will depend on the weight of your baby and the width of the cleft lip. We advise the use of a latex teat because it is softer than silicone, making it easier for your baby to suck. It also moulds to the shape of the mouth. Your CNS will advise you and work together with your hospital nurse and health visitor to help through this time.
Your clinical nurse specialist will also provide you with a couple of bottles and teats and provide information on where to obtain further bottles and teats from CLAPA.
Breastfeeding
Having a cleft lip and palate makes it difficult for your baby to latch on to the breast properly and stay latched on.
You can still put your baby to the breast to stimulate their milk supply, but they must feed from a specialist bottle with expressed breast milk or formula milk. Your clinical nurse specialist will be able to discuss this in depth with you in detail at the assessment.
Breast milk helps protect babies against stomach upsets, ear and chest infections, diabetes and eczema whilst encouraging general development and growth. Alternatively, you may decide to offer your baby a standard infant formula of your choice. You will be offered the loan of an electric breast pump at no cost to yourself for as long as you wish to express milk for a maximum of a year following birth.
We would recommend the use of an electric pump (for example, Ameda or Medela) for expressing. The clinical nurse specialists have a small supply of electric pumps which are available for you to borrow for as long as you wish (these are kindly funded by local cleft charities and charitable funds).
The benefit of an electric pump is that it is usually quicker and more efficient. It is also possible to pump from both breasts at the same time. Some mums may prefer to use a handheld pump. Again, your clinical nurse specialist, in conjunction with your midwife and health visitor, will be able to discuss this with you.
The CNS team will provide ongoing management and regular assessments through a home visiting programme, the frequency of which will be negotiated with you according to your baby’s needs. Feeding will be supported and progressed appropriately and in a timely manner. Support and advice will also be provided around weaning your baby.
Occasionally, new-born babies are unable to feed at the breast or from a bottle. An assessment of feeding skills is undertaken by the Clinical Nurse Specialist soon after your baby is born and will be repeated as your baby develops and changes.
It is important that all babies are given the opportunity to develop feeding skills as they grow. Some babies will require the support of special high calorie milk or a feeding tube to obtain enough nourishment to develop. Your Clinical Nurse Specialist will discuss all the options available to help your baby grow and thrive.
We encourage babies to feed as soon as they are awake and alert enough after the anesthetic. It may take a few days for the baby to get used to the repaired lip or palate, but this rarely causes any long-term problems.
Babies with a cleft lip sometimes experience dry lips and gums. If this happens, simply apply a small amount of petroleum jelly or nipple cream to the area with your finger.
If your baby has a cleft palate, a white area may appear on the central part of the roof of the mouth during the first few weeks. This is usually painless and disappears quickly. It is important to place the teat well into your baby’s mouth on the centre of the tongue. Try to keep the teat still in your baby’s mouth no matter how tempting it may be to move it around to stimulate your baby to suck.
When you go home from the maternity unit your Clinical Nurse Specialist will visit you on a regular basis and provide support until after your baby’s operation(s). As your child grows up, you may contact your Nurse for further help by telephone or during clinic visits.
Common Problems and Concerns
If your baby is sick after a feed you may notice it coming down their nose. This is perfectly normal for a baby with a cleft palate.
Any problems which may arise are usually fairly short lived, but it can sometimes take a few weeks before your baby’s feeding is well established, and they have a good weight gain. Your clinical nurse specialist, working together with your midwife and health visitor, will continue to advise you in hospital and at home.
If you have any problems, concerns or worries regarding feeding, please contact your clinical nurse specialist.
If you have any problems, concerns or worries regarding feeding, please contact your clinical nurse specialist.
Further information regarding breastfeeding can be found on the NHS Start4Life website and the NHS breastfeeding first days webpages.