Feeding should be an enjoyable time for both you and your baby. First get your baby used to spoon feeding. Once your baby is familiar with spoon feeding, you can introduce drinking from a cup. Your baby needs to be completely weaned from bottle drinking and using a cup before they can have surgery to fix their cleft palate. The cup your baby drinks from needs to be leaky and free flowing in order for them to get the liquid out of the spout.
Spoon feeding
Choose a time of day when you have time to spend helping your child get used to the spoon. Try to relax and stay calm while introducing spoon feeding to your child.
Here are a few tips to follow when feeding your baby with a spoon:
- Place your baby in an upright, supported sitting position. Your baby will need more support if they are not yet sitting independently.
- Use a small, flat spoon rather than a larger, deep spoon to make it easier for the mouth and upper lip.
- Offer small tastes of the food to get your baby's attention. Your baby will show interest by having bright eyes, opening their mouth or leaning their head towards the spoon.
Your baby needs to feel in control of each bite while gradually learning how to move new food textures around the cleft palate.
Progress at your baby's pace. Give your child time to taste the food and play with it.
An open cleft can allow food to enter the nasal cavity
An open cleft can allow poorly swallowed food to enter the nasal cavity and come out of your baby's nose. Your baby will likely sneeze to clear the nose if this happens. This is normal for babies with a cleft palate, and it is important to remain calm. Gently wipe their face and stay positive to keep feeding enjoyable. Your baby needs to learn how to move a new food texture past the cleft to prevent this from happening.
If your baby loses a lot through their nose, try giving smaller bites each time and go more slowly. Most children will learn this skill well with time. It is important to know that food in the nose can be uncomfortable but is not dangerous. As long as your child is gaining weight and growing appropriately, this is not a concern.
Common foods you can give your child
First introduce iron-rich foods, such as cereals or purees, to your child. Ask your primary care provider about other foods of different tastes and textures to give your baby.
These are some common iron-rich food you can give your child:
- puréed, minced, diced or cooked:
- meat
- fish
- chicken
- tofu
- mashed beans, peas or lentils
- eggs
- iron-fortified infant cereal
Introduce one food at a time
When introducing foods that are common food allergens (peanuts, tree nuts, eggs, shellfish, fish, milk, soy and wheat), it is best to offer no more than one new food per day. You can also wait a few days before you introduce another common food allergen. This makes it easier to identify a food that may have caused a reaction. Once your child is able to handle a number of foods well, you can start to mix the different types of foods that you offer.
Some foods may be irritating to the nasal passages. Citrus fruits and tomatoes have an acidic quality that can be more uncomfortable. Once your child gains more control in eating with their cleft palate, eating these types of foods will be easier.
Finger feeding is okay
Although it is messy, you can give your baby opportunities to explore food with their fingers to become familiar with food textures through hand-to-mouth experiences. These experiences are especially helpful if your baby refuses food from a spoon.
Cup drinking
Before the operation to repair a cleft palate, your baby needs to be completely weaned from bottle drinking and needs to be drinking from a cup. This is because after the palate repair, the bottle nipple can rub against the stitches and break down the repair.
There is no specific cup for a child with a cleft palate. Several types of cups are available, including cups with lids, spouts, specialized flow spouts and handles. A lid can help prevent too much spillage. The lids come with or without spouts. Spouts can be soft (made out of silicone) or hard (made out of plastic).
Whatever cup a child with a cleft palate uses:
- It must be leaky and free flowing, with no suction needed to get liquid out.
- The spout must be less than 1 inch (or 2.5 cm) long.
Helping your child use a cup
When offering the cup, sit your baby on your lap or in an infant seat or highchair. Gently tip the cup to allow a controllable amount of liquid into your baby's mouth. They will likely sputter, cough and dribble, but do not worry. This reaction is common for all babies when learning to drink from a cup. If this continues to happen, you may want to try thickening the liquid slightly so it flows more slowly. You can do this by mixing strained fruits or vegetables with the fluids you are offering your child.
Choose a particular meal or snack when you will consistently give liquid from a cup, then always offer the cup during this chosen meal.
Weaning from the bottle to a cup
The hardest times to wean a child are typically from the first bottle in the morning and the last bottle before the child goes to sleep. You should choose a meal time that is mid-morning or mid-afternoon because these are the easiest to maintain. Use a liquid your baby likes and is familiar with. For example, if your child is drinking formula from a bottle, then offer this formula from a cup.
If your child becomes upset or is pulling away from the cup at first, give a short break, then try again. Do not offer the bottle immediately after your child becomes upset when the cup is offered because they will quickly learn that if they refuse the cup, you will provide the bottle instead.
Once your child is comfortable using a cup and shows they can drink the same amount of fluid as they would from a bottle, you can begin replacing one bottle feeding with cup drinking. You can then work on a second meal time to offer the cup.
Introduce this new skill slowly. Be supportive, persistent and consistent while your child gradually learns this new skill.
Please contact your occupational therapist if you have any questions or concerns.
References
Caring for Kids. (January 2020). Feeding your baby in the first year. Canadian Paediatric Society (CPS). Retrieved from: https://www.caringforkids.cps.ca/handouts/feeding_your_baby_in_the_first_year
American Cleft Palate-Craniofacial Association (ACPA). Family Resources. ACPA Family Services. Retrieved from: https://cleftline.org/family-resources/
