Cleft lip/CP Flashcards
Cleft lip
- few feeding probs
- able to breastfeed
Occasional probs of Cleft Lip
excessive air ingestion
anterior liquid bolus loss
Cleft lip is aided by…?
labial taping (helps keep skin together), wide-based bottles, breastfeeding
Majority of babies with CP are __________
neurologically intact –> WNL sucking/swallow reflex
CP Feeding Differences & Problems
unable to create oral seal/negative pressure; can’t get full suction
->therefore, unable to breastfeed/use regular bottle
What does an infant with CP have to use to feed?
a special bottle that uses compression only
Common feeding problems of CP (4)
1) excessive air ingestion –> increased GE reflux, uncoordinated S:S:B
2) nasal congestion –> difficulty coordinating respirations during S:S:B (obligate nose breathers & may be liquid in cavities)
3) burden on caregivers for positioning, pacing, and aided extraction –> requires parent education
4) extended feeding times & inefficient feedings –> FTT
What is the one time breastfeeding is not encouraged?
when baby is CP they are unable to breastfeed- physiologically impossible & can’t achieve suctions
CP can’t use:
paci, regular bottles, straw/sippy cup to suck
common CP Dysphagia symptoms (normal for CP)
1) nasopharyngeal regurge (w/ occassional aspiration on post-nasal drip after swallow)
2) pharyngeal residuals - after the swallow (secondary to poor oro-pharyngeal seal & inability to build up pressure; w/ occasional aspiration
Why should you not do swallows for CP on day 2/3 after birth?
wait a couple of days for infant to figure it out and get coordinated; don’t want to mess with diet/system so soon
Feeding expectations of full term CP babies (5)
- Full PO feeding w/in 1 wk
- feedings <30 min
- WFL airway protection during MBSS
- increased air ingestion (and possibly reflux; requires more burp breaks,)
- nasal congestion (NOT laryngeal)
CP bottles
compression based bottles bc CP can’t achieve suction
Types of CP bottles
Haberman (special needs feeder)
Dr Browns cleft bottle
pigeon feeder
haberman bottle
- most popular (60%)
- good for when in hospital; acute care & still learning sucking process; compression-based
- has one-way valve- increases pressure in nipple and keeps liquid from going back into bottle
- can regulate flow by rotating nipple; 3 flow lines
- soft squeezable base to assist w/ milk extraction; pressure higher than in reg nipple so more liquid extracted
Dr. Brown’s
- looks normal- regular dr. brown’s but has additional one-way valve
- can use whatever nipple child needs
- holds milk in nipple to increase pressure; makes extraction via compression
- vent system: helps to not let air be reintroduced; sends air to bottom; swallow less air–> reduces air ingestion/gastro reflux probs
pigeon feeder
- one way valve
- top portion has extra layer of silicone; rigid and gives false palate
- bottom= malleable/soft
- wider and fatter than mini haberman & wider/long than Dr. Browns
- good for low tone or poor sucking pads/kids who needs something to fill up oral cavity
Signs & symptoms of aspiration and referral for MBSS
1) coughing/choking
2) wet breath sounds, crackles during exhalation
3) throat clearing
4) stressful facial expression
5) pulling head back and arching into extension
6) pulling off nipple w/ possible head turning or crying/fussing
7) color changes around lips/face
8) rapid breathing (tachypnea)
9) decreased O2 saturation (if on monitor)
10) frequent sneezing
11) constant low grade fevers
12) URIs/ pneumonia
13) red flag: frequent need for nebulizer or other pulmonary treatments
