In the past eight years, Melisande Ploutz, C-PNP Team Coordinator at the Cleft and Craniofacial Center Golisano Children’s Hospital has noticed a major shift in the way health care providers approach infant feeding with babies born with cleft abnormalities.
Years ago, she says, there was no consideration of breastfeeding for a baby born with any classification of cleft lip or palate.
“We have come a long way,” Ploutz says.
Ploutz currently serves as a liaison between patients, families, and the craniofacial team, assisting families in understanding, coordinating, and implementing their treatment plans.
Recently inspired by her own breastfeeding experience, Ploutz completed the Lactation Counselor Training Course (LCTC).
“The course helped me become more knowledgeable about breastfeeding and lactation, but ultimately helped me become much more competent in my counseling,” she shares. “It helped me to instill that same confidence in [mothers’] ability to breastfeed.”
She goes on to explain that the course has shaped the way she helps families manage their expectations around breastfeeding a baby with medical complexities.
Overall, she hopes to increase the consumption of human milk for babies with cleft abnormalities.
Because cleft lips are almost always caught on anatomic ultrasounds, Ploutz says she can start education about healthy infant feeding prenatally.
“I provide reassurance [to the family] that we have the capability of taking care of their baby no matter what the diagnosis is,” she says. “We talk about infant feeding and all of the possibilities.”
Differently, isolated cleft palates are not detected on prenatal ultrasounds, so education and support for these families begins at birth. Ploutz and her colleagues most commonly encounter babies born with unilateral cleft lips and palates.
“The families I meet prenatally are much more confident during the newborn period, because they were much better prepared,” Ploutz comments.
Overwhelmingly so, Ploutz finds that the parents of babies born with cleft lip and/ or palates plan to breastfeed.
She helps them realize what breastfeeding may look like for their special care babies. There is no reason that a baby born with an isolated cleft lip cannot breastfeed, she says. Experimenting with different positions can help to mould the breast tissue to form a seal so that the baby can breastfeed successfully, for instance.
Differently, Ploutz explains that it is unlikely that a baby born with a cleft palate will be able to exclusively feed at the breast.
“Our number one goal is for the baby to thrive and be healthy for surgery,” she says. “We really reinforce pumping and providing breastmilk for babies.”
Mothers’ milk can be fed to babies with cleft palates through an assistive bottle. Ploutz reports that families may also have access to pasteurized donor human milk (PDHM) through their hospital.
Ploutz emphasizes that breastfeeding a baby with cleft abnormalities requires careful monitoring including frequent weight checks and strong support from primary care providers.
Cleft lip surgery generally occurs around four months of age. Corrective palate surgery happens, on average, before the baby’s first birthday. Ploutz says she especially encourages mothers to feed their babies their pumped milk around the time of the baby’s surgery because its protective properties are profound.
About four years ago, Ploutz, the lactation care team and occupational therapists at their hospital, created a breastfeeding friendly protocol for babies born with clefts. The protocol clearly lays out what can be expected for a baby born with cleft lip and/or palate, Ploutz explains. The protocol describes first feeding the baby mother’s pumped milk from an assistive bottle to meet nutritional needs and then recommends the mother put her baby to breast for “bonus” milk and hormone stimulation. Skin-to-skin is highly encouraged to facilitate bonding and regulation.
Ploutz points out that limited data shows that overall, babies born with clefts are less likely to receive breastmilk.
She says that in terms of her counseling skills, the LCTC “changed everything” for her, and she encourages other care providers to obtain this education and sharpen their counseling skills in order to better support breastfeeding in this population.
“I want to spread the word,” she comments. “Wouldn’t it be amazing if more nurses and team coordinators in the cleft community took this course?”
Ploutz and Healthy Children Project are in the very early stages of brainstorming the creation of a video about breastfeeding babies with clefts. Ploutz says she sees a video as an opportunity to facilitate consistent messaging, clear up misconceptions and help families to feel more confident.