Cleft lip and palate: breastfeeding and prenatal diagnosis

Cleft palate and cleft lip and palate are birth defects that occur during embryonic life and alter the normal formation of the lip, palate, or both.

Cleft lip, also known as “cleft lip”, is an opening or cleft in the upper lip. The cleft palate is an opening in the palate (roof of the mouth).

Cleft lip is a malformation in which cleft lip and cleft palate occur simultaneously.

Some children with a cleft lip have a small slit in their upper lip, others have a larger opening or hole that can reach their nose.

The causes are still not entirely clear.

Scientific research suggests that the malformation is due to both genetic and environmental factors.

In some cases, cleft palate or cleft lip can be associated with genetic syndromes or other diseases, the best known of which is Pierre Robin sequence or syndrome.

Other possible causes are oligohydramnios, myotonia or connective tissue diseases.

A third of patients present with velocardiofacial syndrome.

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Cleft lip and cleft lip and palate: how to breastfeed?

A child with a cleft lip and palate may have difficulty sucking breast milk in the first years of life and taking food later.

The football position, or rugby position, is recommended for breastfeeding.

It is necessary to perform exercises to lower the tongue before attachment to the breast, fill the cleft (schisis) with breast tissue to prevent the milk from escaping through the nose and finally manually squeeze the milk into the baby’s mouth during breastfeeding.

Babies with these problems may have difficulty suckling from a normal bottle, so it’s a good idea to enlarge the nipple holes or use a special nipple.

Possible alternatives are feeding by syringe or dropper, by spoon and/or by applying an acrylic resin plate inside the mouth, in order to create an artificial separation between the cavities. mouth and nose and gradually promote the alignment of the gingival arches.

This will also serve to facilitate the surgery.

In more serious cases, it is necessary to use the nasogastric tube, but for as short a time as possible.

It is important that the mother stimulates the baby with sucking exercises using her finger or a pacifier, in order to maintain the sucking function.

Symptoms:

The main symptoms are:

  • Sucking problems: breast milk, bottle;
  • Dental problems: The child with a cleft lip and palate often has missing, overlapping or crooked teeth. This requires checkups and dental and orthodontic corrections;
  • Speech problems: Some children with cleft lip and palate have difficulty speaking and need speech therapy to learn to speak well;
  • Recurrent ear infections (otitis): Many episodes of ear infections can lead to hearing loss. Specialized visits to an ENT specialist are therefore necessary to determine if a tympanic drain (a small tube in the eardrum) should be placed in order to drain the fluid that accumulates inside and promotes infections.

Diagnosis of cleft palate and cleft palate

The diagnosis of cleft palate is made by the neonatologist/paediatrician after birth during the first visit. In addition to the lips, the integrity of the palate is also checked.

Prenatal diagnosis

In some cases, it is possible to perform prenatal diagnosis during ultrasound scans of the fetus in utero.

The gynecologist will be able to see possible malformations of the lip on ultrasound, but it is difficult to see possible malformations of the palate.

If on ultrasound the fetus has a suspected cleft lip or cleft palate, the doctor will need to take a closer look at the fetus and carefully assess other organs that may be affected.

He will recommend a prenatal genetic diagnosis.

The treatment of cleft lip and palate is essentially surgical.

Prevention:

To date, certain factors are recognized as being able to increase the risks of such alterations in pregnancy.

It is advisable to:

  • Avoid anticonvulsants and methotrexate;
  • NO SMOKING;
  • Do not drink alcohol;
  • Take a multivitamin containing at least 400 micrograms of folic acid for women who are pregnant or planning to become pregnant.

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Source:

Bambino Gesu

Christine E. Phillips