A cleft palate is a hole in the roof of the mouth that results when the right of and left sides of the developing mouth do not form. A cleft palate can have up to three components: A hole in the gum line, a hole in the hard part of the roof of the mouth called the hard palate, and a hole in the muscular part of the roof called the soft palate. There are many causes of cleft palate, but the majority of patients have a spontaneous cleft, which is not the result of anything the mother or father did during the pregnancy.

Proper feeding is an important part of caring for a child with cleft lip and palate. It is an essential part of providing adequate nourishment to the growing child. It can also deliver some degree of immunity from disease early in childhood, and is an important part of the bonding process that occurs between mother and child. The suckling action that occurs during feeding is also important. Suckling helps develop important muscles responsible for feeding, drinking, chewing, speech and sound production. It is also pleasurable to your baby, therefore serves as a source of comfort. Therefore in deciding how to feed a child with a cleft palate, a method should be chosen that requires active suckling.

A full term infant needs 2-3 ounces of breast milk or formula per pound of body weight per day in order to gain weight. It is normal for a baby to lose up to 10% of the initial birth weight within the first few weeks of life. But then, this weight should be rapidly gained back and exceeded. A 2-week-old baby usually receives between 18-24 ounces per day, however nasal regurgitation, length of feeding, and other factors may alter this number. Therefore, babies with a cleft palate should be weighed weekly to ensure that the oral intake is enough. Babies should be fed on a 3-4 hour schedule, and no longer than 30 minute per feeding for optimal results.

Infants with an alveolar cleft (a hole in the gum) only usually do not have problems with feeding. However, a hole in the hard and soft palate can interfere with feeding. The hole initially makes feeding difficult because a suction vacuum cannot be effectively generated inside the mouth to pull milk from nipple or breast. To overcome this problem, specialized feeders are used to give adequate nutrition to the child. When used effectively, the child can grow and gain weight, just like any child without a cleft. Our nurse-feeding specialist is experience in teaching familles how to feed these patients and maintain adequate nutrition. We typically recommend the Haeberman feeder, which allows the parent to squeeze pumped breast milk or formula into the Childs mouth during active suckling. Other feeders such as the Mead-Johnson are also effective, and both can be ordered by contacting our office directly. In pinch, a cross cut nipple that is squeezed or the NUK nipple, both of which are available in Walgreen's can be used. No matter which bottle is chosen, the nipple should be angled to the side of the palate away from the cleft so that your baby has a chance of getting some milk on his or her own by compressing the nipple with the tongue. The baby should also be held upright during feeding in order to decrease the amount of nasal regurgitation. Please consult our feeding specialist to determine which nipple is best for you. 

Breast-feeding is difficult because of lack of suction. However, a few minutes of breast time before each feed is recommended to aid in the creation of the bond between mother and child. After five minutes of breast time, the infant can be fed with pumped breast milk or formula depending on parental desire. The most important thing is that the child is gaining weight and receiving adequate nutrition. For parents who insist on only breast-feeding, there is a feeding tube that can be attached to the surface of the nipple during breast feeding that allows the mother to squeeze extra milk into the baby's mouth during breast feeding. This is typically a second or third choice in terms of feeding techniques, but it can be successful.

It is also common for the milk to come out of the nose. This is called nasal regurgitation and it result from the opening created between the mouth and the nose. When this occurs, stop feeding, allow your baby cough or sneeze the milk out, wipe off the excess with a moist cloth, and then resume feeding once breathing has returned to normal. Your child will learn how to control this with time, and of course it will stop or decrease after the palate is repaired. Babies with clefts often swallow a lot of air when feeding and will need to be burped a lot in order to prevent regurgitation.

We do not recommend the use of an obturator to help feeding. Moist babies do just fine without one. The only exception in the nasal alveolar molding device, which is discussed under the treatment of cleft lip.
A cleft in the soft palate also creates a speech problem in the child. When we speak, the soft palate that contains a variety of muscles, will intermittently close off the nose from the mouth. This is important in the creation of certain sounds like s, b, p, etc.. When there are problems creating these sounds, the patient is said to have velopharyngeal insufficiency or VPI. Without proper closure and repair of these muscles, normal speech can never be expected. With proper surgery, most children will have normal speech (national average is 75%), however speech therapy is frequently required.

The cleft palate is closed between 9-18 months, depending on the speech and growth patterns of the effected patient. Complete closure of both the hard and soft palate are performed at the time of surgery. Using our technique, the need to perform a surgical procedure to correct speech problems in less than 5% (far better than the national average).

Children should not have anything to eat or drink and least 6 hours before surgery. The surgery typically takes 2 hours. During that time, we will close the hole in the roof of the mouth, create one uvula, and bring together the muscle of the hard palate using a procedure called an intravelarveloplasty. This technique placing the muscles essential for proper speech in a normal position. It is done with special magnifying lenses or a microscope to increase precision. At the end of surgery, your child will have dissolving sutures inside his or her mouth. They will be watched closely for any problems with breathing, and nursing specialist will work with you to start feedings as soon as possible. Feeding is liquid only for 2 weeks via a sippy cup or a syringe. Your child may also wear elbow immobilizers during this time to prevent the placement of any unwanted objects inside the mouth.  The immobilizers can be taken off when your child is being held.

After 2 weeks, the palate should be healed, and we will send the patient back to the team speech therapist to observe and enhance speech and language development.