The feeding requirement of a cleft child is as much as that of a normal child. The child however, requires special care in feeding because of the cleft. The problems which generally occur in such children are :

Regurgitation (Coming out) of milk or any food from the nose.

The child tends to swallow a lot of air during feeding.

Frequent bouts of cough dure to passage of food from food pipe in to wind pipe.

• The child tends to get tired of feeding.

All these problems lead to failure of weight gain and low hemoglobin. The operations can not be done under these circumstances and the complete time table of the management is disrupted. Here we suggest some measures to overcome most of these problems to a significant extent.

1. Hold the child in semi reclining position while breast feeding or spoon feeding. See that his head remains at a higher level than his stomach. His should be straight, not tilted sideways or bend forwards or backwards. This will help food go properly in to the food pipe and will also prevent it from coming out of the nose.

2. After feeding hold the child on your arms and gently tap his back. The child will burp and all ingested air will come out.

3. Follow the feeding pattern of time feeding rather than demand feeding. That is, do not wait till the child cries for its meal. Feed the child every 2 hour and at least once in the night time.

If the child is being spoon fed, it is important to prevent diarrhea. Use only boiled and cooled milk or pasteurized milk. Keep the spoon and the cup in boiling water for about 20 minutes. Clean your hands before every feed. While spoon feeding, make sure you put the food nearer the back of the tongue and not just in the front part of the mouth.

Breast Milk is the best food for your child. It contains all important nutrients and is easy to digest. It also provides the child with antibodies necessary to protect against several diseases. Hence for any child, including the child with the cleft, breast feeding is the best.

Some doctors also believe that the breast feeding improves the muscle mass around the lip which helps during repair of the cleft.

A child learns breast feeding in about 24 - 48 hours. This also applies to children with clefts.

 Breast Feeding in Patients with Cleft Lip: In patients with isolated cleft of lip, breast feeding may not be a problem as the child has an intact palate. If however, child finds it difficult to suckle, the cleft can be blocked by mother’s thumb as shown in figure.

 Breast Feeding in Patients with Cleft Palate: Children with clefts of the palate are not able to generate enough negative pressure. Hence it is necessary to use some special methods for feeding them. The method is explained in figures given bellow. In cases where the cleft is one sided, it may sometimes, help the child if the nipple is kept inside the mouth on the other normal side. If breast feeding is still difficult, the mother’s milk can be extracted with breast pumping in a clean cup and can be given with spoon. Pleas boil the spoon and the cup as explained above. If the child gets exhausted while feeding, the remaining breast milk can be extracted and the child can be fed with the spoon and cup. Before breast feeding, take a clean piece of cloth, wet it in a warm water, and wrap around the breast for about 5 - 10 minutes. This helps to ease the milk flow and thereby helps the child to suckle easily.