Breast-feeding the baby with special healthcare needs: cleft lip or palate and cystic fibrosis.

Breast-feeding offers several benefits for the child who is born with a cleft lip or palate. It promotes proper development of the mouth and face by strengthening facial muscles. The flexibility of the breast also allows babies with a cleft lip or palate to achieve better closure for sucking than they would with a rubber nipple.

Babies with a cleft palate experience more ear infections because the muscles of the palate do not properly open the inner ear tubes. This allows fluid to collect and provides a medium for infection. Eighty-five percent of children with cleft palates in a 1994 German study developed hearing problems caused by ear infections. Breast-feeding helps to decrease the incidence of infection for these children. Since breast-feeding provides a baby with increased immunities against infections, this risk is lowered. Over the course of a 1994 US study, babies with cleft palates who were breast-fed were free of ear infections at 32 percent of office visits compared with just 3 percent for those fed cow's milk or soy formulas.

Overcoming problems

Nursing can be difficult if the baby has trouble achieving complete suction. Incomplete suction causes inefficient nursing. The baby has to work very hard to get a small amount of milk. If the baby is nursing for long periods, yet crying to indicate hunger frequently, even within minutes of the last feed, this is generally the problem. The baby may require supplemental feedings of either expressed (pumped) breast milk or formula until he or she is strong enough to nurse effectively. Some mothers have found that they can use a thumb or forefinger to fill the space above the cleft lip, thereby helping the baby form a complete seal.

Problems of positioning or "latching on" can also contribute to the problem of ineffective nursing, but this can be corrected with practice. It is best to begin with practice. It is best to begin experimenting with nursing positions in the first few days after birth when the breasts are still soft and pliable. Once the mother's milk supply increases, her breasts become more firm, and it will be more difficult for a baby to learn to "latch on" and suck effectively.

The upright position is easiest for babies who have cleft palates as it prevents milk from leaking into the baby's nose which could cause choking. When experimenting with different positions, the mother should use pillows to support the baby so that she does not tire or become sore. Some mothers benefit from having a La Leche League Leader or other qualified breast-feeding counselor observe a feeding session to offer suggestions on positioning.

Though it may take more effort at first for a baby with a cleft lip or palate to master the technique of breast-feeding, nursing will get easier with time. La Leche League Leaders are available to consult with new mothers from their first feeding in the hospital. Although first feedings may be exhausting for both mother and baby, it is important that the baby nurse long enough to receive the full nutrients of a nursing session. Without the rich hindmilk (the rich milk which is produced at the end of the feeding) he or she will have difficulty gaining weight. This is one situation where we recommend that the other mother set the feeding pace to ensure frequency and duration of feedings. The La Leche League Leader can instruct the mother in how to determine whether the baby is receiving the hindmilk and give her techniques to help the baby drain the breast milk more efficiently.

Palatal obturators

Healthcare professionals often suggest that a baby with a cleft palate be fitted with a palatal obturator, a device that fits on the roof of the mouth. An obturator is used to prevent the baby's hard palate from closing improperly until he or she is old enough and strong enough to undergo corrective surgery. If requested, the obturator can be made with a smooth surface to accommodate breast-feeding.

It allows better and easier sucking, and often reduces the size of the cleft. At first, the baby may be uncomfortable breast-feeding with the obturator in place. After a day or two, however, the baby will become more accustomed to it and, with encouragement, should eagerly resume nursing. The La Leche League Leader can help with this adjustment.

Breast-feeding after surgical repair of cleft lip or palate

Most babies born with a cleft in the lip or palate undergo surgery in the first few months of life. Breast-feeding at this time not only provides nutritional benefits and protection against infection, but can also comfort and reassure both the baby and mother during this stressful time.

According to studies done in 1987 and 1992, in most cases, nursing can resume immediately after surgery to repair a cleft lip. After cleft palate repair, the child may be uncomfortable and not want to nurse immediately. If the mother can maintain her milk supply and bottle-feed the baby the expressed milk, then breast-feeding can probably resume within a week.

Cystic fibrosis 

In a 1990 survey of US cystic fibrosis centers, most health care professionals dealing with this disease recommend breast-feeding. Cystic fibrosis causes babies to develop unusually thick mucus that clogs the bronchial tubes, making it hard for them to breathe. The mucus also blocks secretion of pancreatic digestive enzymes so that babies cannot completely digest their food.

Human milk is gentle enough for easy digestion. A 1991 Australian study found that babies with cystic fibrosis who were exclusively breast-fed were both heavier and taller than babies with cystic fibrosis who were fed formula.

Babies who have severe cases of cystic fibrosis have difficulty gaining weight and may require additional enzymes to assist digestion. These additional enzymes can be stirred into soft foods, such as applesauce, or they can be mixed into expressed breast milk and given by bottle after the baby has finished a breast-feeding session.

For more information or to find a
La Leche League Leader near you,
contact:
La Leche League International
1400 North Meecham Rd.
Schaumburg, IL 60173-4080
Telephone: [phone]
Web: http://www.lalecheleague.org/