Cleft lip/CP

Question 1

Cleft lip

Answer 1

• few feeding probs

- able to breastfeed

Question 2

Occasional probs of Cleft Lip

Answer 2

excessive air ingestion

anterior liquid bolus loss

Question 3

Cleft lip is aided by…?

Answer 3

labial taping (helps keep skin together), wide-based bottles, breastfeeding

Question 4

Majority of babies with CP are __________

Answer 4

neurologically intact –> WNL sucking/swallow reflex

Question 5

CP Feeding Differences & Problems

Answer 5

unable to create oral seal/negative pressure; can’t get full suction

->therefore, unable to breastfeed/use regular bottle

Question 6

What does an infant with CP have to use to feed?

Answer 6

a special bottle that uses compression only

Question 7

Common feeding problems of CP (4)

Answer 7

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

Question 8

What is the one time breastfeeding is not encouraged?

Answer 8

when baby is CP they are unable to breastfeed- physiologically impossible & can’t achieve suctions

Question 9

CP can’t use:

Answer 9

paci, regular bottles, straw/sippy cup to suck

Question 10

common CP Dysphagia symptoms (normal for CP)

Answer 10

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

Question 11

Why should you not do swallows for CP on day 2/3 after birth?

Answer 11

wait a couple of days for infant to figure it out and get coordinated; don’t want to mess with diet/system so soon

Question 12

Feeding expectations of full term CP babies (5)

Answer 12

• 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)

Question 13

CP bottles

Answer 13

compression based bottles bc CP can’t achieve suction

Question 14

Types of CP bottles

Answer 14

Haberman (special needs feeder)
Dr Browns cleft bottle
pigeon feeder

Question 15

haberman bottle

Answer 15

• 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

Question 16

Dr. Brown’s

Answer 16

• 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

Question 17

pigeon feeder

Answer 17

• 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

Question 18

Signs & symptoms of aspiration and referral for MBSS

Answer 18

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