When the nurses handed Rose her second baby, the cleft lip and palate was evident. She was beautiful though. So her outmost worry was not the split lip but the reality of how to breastfeed and care for her baby. Shortly after birth, she tried to breast feed her just like she had done with her previous babies. Breast feeding was not rocket science to her. The baby wanted to suckle but she could not hold the nipple in her mouth and after hours of trying to suckle without suction, it was evident that the baby’s sugar levels were going down. She feared she could die of starvation.
A cleft is a gap or split in the upper lip or palate the roof of the mouth. In Uganda, the prevalence rates are reported between 0.8- 1.3 per 100,000 live births which is approximately 1,100 babies born with clefts annually.
Infants with cleft lip and especially with a palate usually have problems feeding largely because they are unable to “suckle” during breastfeed. They take longer to feed, swallow more air and easily aspirate or choke during their feeds. They frequently suffer ear and chest infections as a result of the aspirations. Malnutrition is commonly seen in cleft lip and palate infants.
How to breast feed their babies is the most common question that health workers encounter from mothers of babies born with cleft lip and palate. To best understand how to breast feed cleft babies we need to first define and understand the parameters of breast feeding. According World Health Organisation, exclusive breastfeeding is when the infant receives breast milk; it includes milk expressed or milk donated from another nursing mother, ORS and drops. Cautious to note is the fact that expressed breast milk, donated breast milk, breast milk along with supplemental formula counts as breastfeeding.
Depending on the severity of the cleft and palate, breastfeeding a cleft baby requires more effort for both the mother and child, but with determination and patience these children usually pick up and weigh just as good as babies without oral-facial problems.
It is important that these babies feed well to prepare them for surgery. A child with cleft lip and palate can feed in a number of ways which include among them; on the breast, pumped and donated milk served in specialized feeding bottles and spoons. Believe me this is breast feeding the harder way.
The infant with cleft palate can also be assisted to feed better by holding the child more upright at about 45⁰ during feeding as well as position the nipple to the side of the mouth that is not cut. In the absence of suction mothers need to manually express breast milk into the baby’s mouth. Experts also suggest supporting the infant’s chin to stabilize the jaw during sucking and supporting the breast so that it remains in the infant’s mouth.
Just as in normal breastfeeding, knowledge support is important. A lot of the fears that the parents have are due to lack of information. With the information in place, most mothers report being more in control and less stressed about their babies’condition.
Nutritional rehabilitation is required for the infants that are malnourished, to prepare them for safe surgery and is usually continued for a while after the surgery. Breast milk contains lysozyme and epithelial growth nutrients that help prevent infections in wounds.
Repair of the cleft lip & palate is performed by surgeons specially trained in cleft repair. Presently, there are several hospitals in Uganda where cleft repairs are performed free of charge, thanks to funding from Smile Train.
By Kirabo Rehema
Communication Officer- CoRSU Hospital