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Cleft Lip and Cleft Palate: Spoon Feeding and Cup Drinking

Spoon feeding

Feeding should be an enjoyable time for both you and your baby. Choose a meal where 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 he is not yet sitting independently.
  • Use a spoon with a flat bowl rather than a deep bowl 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 his mouth, or leaning his 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 his 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 his 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 life-threatening. 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 pablum and cereals to your child. Ask your paediatrician or family physician about other foods of different tastes and textures to give your baby.

These are some common types of food you can give your child:

  • infant cereals
  • pureed baby foods (veggies, fruits, and meats)
  • minced foods

Introduce one food at a time

Introduce only one new single-ingredient food at a time. Wait 3 to 7 days before you introduce another new food. This way, you will know whether your child will have a reaction to a certain type of food. 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 his 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 his 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 effectively drinking from a cup. This is because after the palate repair, the bottle nipple can rub against the stitches and break down the repair.

You can introduce drinking from a cup after your baby becomes familiar with spoon feeding.

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. Most parents want a lid to help prevent too much spillage. The lids come with or without spouts.

Cups with spouts

If you choose a cup with a spout, the valve that controls the flow in the spout needs to be removed because your baby will not be able to create enough suction to draw the liquid from the spout. Liquid needs to flow freely through the spout. To test the flow, fill the cup with water and see how fast the liquid flows through the spout.

Try to find a spout that is very short. Cups with long spouts are not recommended, as these may rub against the cleft palate repair. Some parents find that cups with a soft, short spout are gentler on teething gums.

Lids without a spout

There are also lids without a spout. A non-spouted lid challenges the baby to learn new lip and tongue skills that are similar to drinking from an open cup rim when the lid is removed. This may be difficult at first, but for some children, this makes it easier to use an open cup, compared to using a spouted lid and then an open cup.

Every child is different, and some might need to use a lid with a spout before drinking from the rim of a cup. With some trials you will learn what works best for your child.

Helping your child use a cup

When offering the cup, sit your baby on your lap or in an infant seat or high chair. Gently tip the cup to allow a controllable amount of liquid into your baby’s mouth. He will likely sputter, cough, and dribble, but don’t worry. This reaction is common for all babies faced with 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 he will quickly learn that if he refuses the cup you will provide the bottle instead.

Once your child is comfortable using a cup and shows he can drink the same amount of fluid as he 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.

Key points

  • Before the operation to repair a cleft palate, your baby needs to be completely weaned from bottle drinking and effectively drinking from a cup.
  • Feeding should be an enjoyable time for both you and your baby.
  • When spoon feeding, first introduce pablum and cereals to your child.
  • After your baby becomes familiar with spoon feeding, you can introduce drinking from a cup.
  • Introduce these new skills slowly and consistently.

Sharon Samaan, MSc(OT), OT Reg. (Ont.)

Cindy Guernsey, RN, BSc

Maggie Harkness, MSc(OT), OT Reg. (Ont.)

Veronika Langos, RD

5/21/2010

 

Recommendations have been adapted from the following:

"Weaning from Bottle to Cup Prior to Palate Repair Surgery" by L. Burton

"Cleft Lip and Palate: Helping Your Child Transition to Strained and Lumpy Foods" by Dunn Klein and Delaney





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