QUESTION:

I have been using the Ross (cleft palate) nipple most recently with my newborn cleft babies. It seems to be working really well. I feel pressure to use the Habermann since we have a few boxes in stock but I never seem to have luck with that bottle. Does anyone else seem to have trouble with the Habermann, or is there something that I could possibly be doing wrong?

ANSWER:

Over tightening can “crimp” the disk and obstruct flow and collapse the nipple. Just gently hand-tighten the ring, don’t turn it hard. It gets easier to do the more you use it 🙂

Also the Habermann can be used very effectively without squeezing of the teat. I have had newborns with complete cleft of the soft and hard palate, such that all that was left was the boney nasal septum; they can effectively get flow via their using only their own active compression.

Know that when we squeeze to deliver flow it is likely very challenging to deliver the right amount, even with attending very carefully to the infant’s cues to guide us. That makes it hard to avoid “overfilling the valleculae” and increases risk for bolus mis-direction toward the airway. The long soft palate of the newborn actually sits in the vallecular space, to help create a “bolus accumulation” site that helps “contain” the fluid which, in the normal newborn, is actively “driven” into the valleculae. When the soft palate is cleft, that “seal” is breeched and squeezed flow has the great potential to be beyond the infant’s capacity and to move toward the airway. This has the potential to occur even when we try our best to limit the squeeze/bolus size, since we cannot “see” in the valleculae at bedside to objectively know that the valecullae are getting too full. Let the infant self-limit the flow rate by not squeezing. You can then use co-regulated pacing as needed if the infant “gets ahead of himself”. One of the benefits of the Habermann is that when baby stops sucking, there is no flow.

The Dr. Brown’s Specialty feeder is beneficial as it allows the infant to regulate the flow, provided the caregiver selects a proper nipple flow rate to start with ( typically premie or  level 1, for example)

Safety is always enhanced with infant-guided regulation of flow rate.