Everyone wants to give their children the most valuable thing: a healthy, happy life. How new parents feed their newborn infants is influenced by family traditions, social customs, cultural values, and previous feeding experiences. To meet the nutritional needs of a child with cleft lip and palate, a combination of feeding foods, feeding positions and feeding techniques should be considered. This article is designed to help you understand what problems you may encounter when feeding a child with cleft lip and palate and how to overcome them so that the feeding process is both nutritious and enjoyable. Feeding experience Feeding plays an important role for all infants, the most important of which is to provide the nutrients needed for growth and development. Not only that, but the feeding process also strengthens the parent-child bond, exercises the infant’s oral muscles and helps the infant gain pleasure. So when choosing a feeding method, these points should be taken into account. Eating is the baby’s main activity. The parent-child interaction that occurs during feeding promotes positive emotions and strengthens the parent-child relationship. The sucking action requires active movement of the tongue and other muscles of the mouth. The development of these muscles helps the baby to successfully perform future motor tasks such as drinking from a cup, chewing, speech, and articulation. In addition, the feeding process should be pleasurable for the baby because of the sucking, so the best feeding technique is to allow the baby to actively suck. Nutrition for babies A full-term, healthy newborn baby needs 2 to 3 ounces (50 to 90 ml) of breast milk or formula per pound of body weight per day to get enough nutrition to gain weight. Therefore, an infant weighing 8 to 10 pounds (3.6 to 4.5 kg) needs 16/24 to 20/30 ounces (450/680 to 570/850 ml) of breast milk or formula per day, which is equivalent to one can of ready-to-feed formula sold in the supermarket. It is normal for newborns to lose 10% of their body weight in the first week of life; do not be anxious, but only gradually increase the amount of food the infant eats. By the second week of life, infants should be eating an average of 18 to 24 ounces (510 to 680 milliliters) of breast milk or formula per day. Problems with feeding a child with cleft lip and palate include nasal reflux (the medical term for food coming out of the nostrils), long feeding times, and individual differences that affect the amount of food the child actually eats. Therefore, it is important to maintain a calm state of mind. For the first 4-6 weeks of life, weigh your baby once a week, preferably on the same day of the week, at the same time, using the same scale. This way, both you and the doctor will know exactly if the baby is developing normally. After feeding habits are established, most babies eat for no more than 30 minutes at a time. If the time is exceeded, it means that the baby is eating too hard, but it is affecting the growth, and you should consider improving the method. As far as the interval between meals is concerned, babies who eat a meal every 3 or 4 hours grow better than babies who eat a meal in less than 2 hours. Babies who eat too often eat like snacks, just eat until they are not hungry, and do not meet the nutritional needs of the developing body. Finally, discuss your baby’s feeding more with a reliable doctor, not from personal experience or taking things for granted. Feeding difficulties for babies with cleft palate There are usually no major problems in feeding babies with cleft lip or cleft lip with alveolar cleft. Like all newborns, cleft lip babies learn to hold their nipples very quickly after birth. However, feeding techniques, nutritional availability, and feeding positions are different for babies with cleft palate. This is because babies with cleft palate do not have a normal separation between the oral and nasal cavities, resulting in weaker sucking ability, possible nasal reflux of food, prolonged feeding, and uncoordinated swallowing and breathing movements. To suckle, babies with cleft palate have to hold the nipple in place with their tongue and defective palate in order to suckle. As a result, they tend to suck in too much air during suckling and often need to burp and vent. Many similar problems require appropriate techniques to solve. How to feed a baby with a cleft palate Regardless of your choice of feeding method, most doctors agree that breast milk is the best food for newborns. The American Academy of Pediatrics recommends breast milk up to one year of age. If breast milk is not enough, your doctor can help you choose a formula with the best nutrient ratio for your baby’s digestive system. If the formula used needs to be made up or diluted, read the product instructions carefully to make sure it is properly formulated. There are several bottles and teats on the market that are designed for babies with cleft lip and palate. When selecting a bottle and pacifier, pay attention to the following points: 1. A thin, soft pacifier is easy to suck; 2. The amount of milk coming out of the pacifier is moderate, not too fast and not too slow; 3. The pacifier should not interfere with normal swallowing function and normal muscle movement of the mouth and face. Many parents also want bottles that are not too special in shape, easy to buy and not too expensive. No matter what kind of bottle and pacifier you choose, the purpose is to make feeding easier for you and better for your baby to suck. Therefore, a relatively soft pacifier is better than a relatively hard one. If a special pacifier does not fit, you can choose a pacifier for premature babies because it is very soft. When the baby grows up and gets stronger, the pacifier should be upgraded, otherwise the pacifier will be deflated when the baby sucks on it and cannot get milk. Some babies with cleft palate are not feeding well because the pacifier may be too short or too long. If the pacifier is too short, the contact area between the baby’s tongue and palate and the pacifier is too small and the baby cannot contain the pacifier; if the pacifier is too long, the baby cannot contain the expanded part of the pacifier and cannot contain it tightly. Sometimes you can use a Ross pacifier, which is soft and shaped like a tube, so your baby can just suck gently and let the milk pass directly through the cleft palate. Many doctors recommend cross-over pacifiers, which take advantage of your baby’s normal sucking and swallowing rhythm to control the flow of milk, because cross-over pacifiers only open when your baby is sucking. The normal larger round pacifier opening will make the milk flow continuously, which the baby cannot control by itself, increasing the difficulty of coordinating the baby’s breathing and swallowing action and easily causing choking and coughing. If you do it yourself, any pacifier can have a cross-shaped opening cut with a single-sided razor blade. Other suggestions It is important to keep your baby in the proper position when feeding. Feeding your baby upright can reduce the amount of milk that comes back out of the nose. The breastfeeder can be in a seated position with one or both feet on a small stool, using the legs to elevate the baby; you can also use a pillow to support the baby’s body to make him/her more comfortable. Keep in mind that even with the proper position, sometimes there will still be milk backflow from the nostrils. If there is milk regurgitating from the nostrils, pause the feeding and let your baby cough or blow the milk out on his/her own. With a short pause, your baby will be able to clear the milk from his or her nose on his or her own and can continue eating. Babies are better off eating when they are moderately hungry, not when they are very hungry. Therefore, parents should feed their babies just after they wake up. Signs that a baby is waking up from sleep include: eye rolling with the eyelids closed; mouth wriggling; and holding the hand close to the mouth. Most children with cleft palate can be fed well using the feeding techniques described in this article. However, for children with wide clefts, doctors may recommend special cleft palate feeding aids, such as palatal guards and palatal obstructors. A palate guard is a plastic palate guard made by the doctor after removing a model of the oral palate from the baby’s mouth. It is worn in the baby’s mouth to fit the palate and partially close the oral-nasal cleft. A specialist in dentistry is available to make, adjust and regularly check the palatal guard.