Problems

Children who are born with a cleft lip, but have an intact gum line can mostly be breast fed normally. However, there still can be some problems during breastfeeding (T.E.S.S. Unlimited, 2013). Because of the gap in the lip, it can be necessary to change the position for breastfeeding so that the breast tissue fills the gap in the lip or gum.

However when a child has a cleft palate, feeding is much more difficult because there is an open space into the nasal cavity. The baby has to swallow fast between breaths so the milk is not regurgitated through his nostrils. There also can be problems because of the fact that the child cannot generate a seal around the nipple, which will decrease their ability to suck. This also causes a use of a bigger amount of energy to drink and will increase the calories the child needs. This can cause that the child uses more calories than it is taking in and can get extremely mal nourished.
The inadequate seal around the nipple or bottle can also lead to swallowing more air that will lead to extra gas in their stomach (About.com, 2013).

Choking

When a child with a CLP cannot regulate the milk flow by itself there is a possibility of choking. This happens when the nutrition directly floats to the throat. This can happen with a too big round hole in the top of the pacifier. With a small horizontal opening the milk will spread evenly through the baby’s mouth and the baby has to collect the milk by itself. When the opening is on the side and not on top of the pacifier the milk will go in the cheeks and not directly in the throat. It is also important to keep the baby straight up so that the milk will not go directly to the throat (Schisisteam Friesland, 2013).

Air in the stomach

Because of the problems with the coordination of sucking, swallowing and breathing there is often a lot of air swallowed with the nutrition. This will give a full feeling because of the larger volume in the stomach. This will cause that the child will stop drinking earlier. The air in the stomach and bowels will form gas that can lead to convulsions. The most important solution is to make sure the child can burp multiple times during the feeding. When you feed by bottle you have to make sure that the pacifier is always full of milk (UMC Utrecht, 2013).

Regurgitate

The baby can throw up a little nutrition during or after the feeding, this is normal. It is also normal when the baby throws up a little bit more because of escaped air bubbles. Sometimes this will happen after the feeding. It is because of the closure between the stomach and esophagus is not yet full grown. When there is very much of nutrition coming out, it can have another cause and it is advised to see a doctor (Schisisteam Friesland, 2013).

Solutions

To guide the jaw and palate grow in a good way, some children with a cleft palate get a palate plate. An advantage of the plate is that it makes the feeding easier. The plate will close the gap in palate, which makes it easier for the child to suck vacuum.

When a child only has a cleft lip, the mother can close the gap by pushing her breast against it. She can also use a soft cloth or a finger to close the gap. This will also make it easier for the child to suck vacuum (N.V.S.C.A, 2012).

Other tips

-          Warming and massaging of the breast before breastfeeding will stimulate the milk flow.

-          When the child is tired quickly, it can be better to give the child small portions multiple times.

-          When the child can drink from the breast, but not enough,  the mother can put milk in

            bottles with the use of a breast pump.

-          Make sure the child is in a good position.