You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Ethan Nipple: A Father's Unique Post Op Feeding Device

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Subject: 

The Ethan Nipple: A Father's Unique Post Op Feeding Device

WARNING: Below are directions for making a unique nipple assembly that can be used to feed a baby post-operatively. If you choose to make this nipple you MUST show the finished assembly to your doctor before offering it to your child. This is to ensure the safety of the nipple as well as to make certain that your doctor is aware of and agrees to your feeding method.

Ethan Nipple

by Frank Maddin

I would ask that the term used for this nipple be called the Ethan Nipple after my son (hey, just who is this Haberman guy anyway? <g>) The long name will be the Ethan Maddin Post-Op Cleft Palate Latex Nipple simply because it's more descriptive and it puts his last name in there - just for fun! NOTE: I did get permission from a doctor before I tried using this with my son.

What is it?

In short, it is a nipple created from the finger a latex glove wrapped around a cut-off nipple base. The end result is soft and supple, maintains the look of a nipple, and can be used with squeezable bottles.

Benefits

Does not hurt the healing palate because it is so soft and giving. In my experience the syringe carries a danger of accidentally hitting the gums, tongue, or palate of a struggling child.

Quick feeding times. We were actually able to feed our child faster with this nipple than we were with the Mead Johnson Cleft Palate Nurser (MJCPN). We can get 5 to 7 oz down him in 5 to 10 minutes now versus 15 to 20 minutes pre-surgery.

Much easier delivery of milk to the baby than syringe or cup. You do not have to continuously pull the food away and give it back to them waiting for swallow time.

The nipple looks similar to a regular nipple when inflated. It's not some strange looking thing coming at them.

Baby can still gum the tip of the inflated tip of the nipple. I would not recommend putting the whole nipple in the mouth and I have not tried it due to the fact that I'm afraid that much suction might harm his sutures.

The syringe and cup gave Ethan a great deal of explosive gas because he was gulping his milk in great doses and crying. I have noticed that he has had little problems with this nipple because he is happy feeding.

Disadvantages

Would not think that this would be very useful for Pre Operation feeding therefore the name. The nipple is far to soft to aleve a babies sucking desires.

Nipple tends to deflate when you are not squeezing. This is not really a problem, just different. You may want to unscrew the nipple ring periodically to let the squeezable bottle return to shape.

It is easy to use if your are used to the Mead Johnson CPN. Small learning curve.

I really have not found much of a disadvantage compared to other Post-Op feeding methods. I have not used nor held a Ross Cleft Palate Nipple but I ordered some before we found this solution. I don't think I will even bother trying them when they come as they are very different from what he is used to.

How to make an Ethan Nipple:

Supplies:

* Small pointed scissors * One nipple

The base of the nipple needs to be as firm as possible and the underside should be flat (free of raised areas present on some nipples). I used the nipples that come with the Mead Johnson Cleft Palate Nurser.

*One latex surgical glove washed of talc powder on the outside and inside. Vinyl gloves do not stretch enough.

* One nipple ring

* One Mead Johnson Cleft Palate Nurser.

This is what we used to feed our baby for pre-op. The real key here is that it is squeezable.

Construction Process:

Take scissors and cut the finger of the latex glove off at the base of the finger. The finger you cut depends on the size of the glove. With small gloves I use the second finger. With large gloves I use the pinky. Snip a tiny slit in the tip of the finger.

Take scissors and cut the top of the nipple off close to the ridge that snaps into the nipple ring. Discard the nipple top. You will be left with only the nipple base. There needs to be enough of a ridge left to snap into the nipple ring. Anything over that is excess that may or may not interfere with the feeding depending on length.

Stretch the base of the latex pinky finger over the nipple base so that the latex overlaps to the under side of the nipple base. This is important to get an air tight seal on the bottle. This can be difficult for some people to do. You have to find a technique that works for you. I hold it open with two fingers of one and and insert the base with the other. You will find out if your nipple base is firm enough on this process. Some nipple bases will fold in under the pressure of the latex finger. Some warping will be straightened out by screwing the nipple onto the bottle. The finished nipple should look much like a normal nipple but of course it will be extremely collapsible.

Snap the newly made latex nipple into the nipple ring. It will be more difficult than a normal nipple to insert because you can't pull on the tip of the nipple to pull it through. If there is a problem try pulling the rim of the nipple base from below toward the center to get it to snap in.

You now have an Ethan Nipple ready to go on a squeezable bottle.

Instructions on Use:

Practice getting the right squeeze amount by just squirting water out of the nipple. Practice getting the right size slit in the nipple. You may even want 2 slits. Different size holes will require differing squeeze amounts.

Some times the milk stream will go in one direction. I try to angle this toward the tongue. This avoids spraying the roof of the mouth with the milk and possibly creating an unpleasant sensation or coating the sutures with milk that makes cleaning even tougher.

Place just the tip of the nipple in the babies mouth. You can experiment with how far you can go. Generally you lose less milk by placing it slightly further inside the babies mouth. There is very little to no suction created in the babies mouth using the tip. I would not recommend putting the whole nipple in the mouth and I have not tried it due to the fact that I'm afraid that would create too much suction might harm his sutures. If suction is being created you can either move it further out or move it to the side of the mouth.

Squeeze as you would with the MJCPN. We used constant pressure with our baby and he was used to that. I would imagine that some parents try to squeeze with the babies suck.

Authors Note: We are currently feeding Ethan in his car seat because the cradle feeding position is currently ruined for him.

Other Hints:

I suggest trying this nipple and/or cup feeding with your baby BEFORE surgery to get them used to it. Feed them once a week, once a day, or whatever it takes to get them use to a post-op method of feeding. When Ethan was just 5 days old we had no problems cup feeding him. We moved on the Mead Johnson Cleft Palate nurser because it was much easier and dropped cup feeding all together. Lucinda tried to get Ethan used to the cup for a month and a half before the surgery without success. We paid dearly for that, but something good did come out of it - the Ethan Post Op Nipple! I only hope it helps someone else and can save them the pain we went through.

History:

My 6 month old son Ethan Lee Maddin had his cleft palate surgery done recently. My son would not take a syringe and would not take a cup. We tried for 6 days and we never got more than 2 oz down him. Typically we got 1 oz. It was never without a struggle. He cried constantly during feeding and toward the 6th day literally tried to buck his way out of our arms. On the 4th day in the hospital at 2 am while I was trying to go to sleep on the floor (At this Columbia hospital they have wonderful policies of only one parent to a room at night which we were ceremoniously breaking and they would not supply anything extra to sleep on because of that policy. Please call your hospital ahead of time and find out their policy on this. Complain loudly if it is like ours.) Thinking that the syringe and cup looked like it would never work. I was racking my brain thinking that he needed something familiar that wouldn't hurt his palate if it slipped and went to far into his mouth. Something with better flow control and would not need to inserted and un-inserted in endless cycles. Necessity is the mother of invention. I thought of using surgical gloves to create a nipple. They were sitting right there in our hospital room. I got up and made Version A of the nipple right then and there before it left my mind or I fell asleep. This version simple stretched the latex over the nipple ring. It was a failure when I actually attached it to the bottle and tried to squeeze. I almost gave up. I then came up with Version B which wraps the latex around a cut off nipple base.

To test flow at first, I was filling up latex gloves with water and cutting small slits in the finger tips, squeezing, sucking on them to see what it felt like. I'm glad no one saw me, it must have been a sight. I went to sleep with visions of being a hero and saving my son from this torture. I was crushed when it did not work the next morning. He seemed to want it at first but then refused and cried just like with everything else. Back to the other methods until day 6 when I would try again.

It should be noted here that we were not shown the correct way to feed our baby from the start and I believe that this was the main cause of our problems. We had forced milk down him so many ways, so many times, with so many different people that he would not go into the cradle feeding position without crying or struggling. After 5 days of about 1 oz feedings he was in weakened state so he ate a bit more for the feeding specialist however he was crying the whole time. We went home. We had four 2 oz feedings in him when he picked up strength and it served to make him stronger to resist the next few feedings in wildly unpleasant ways such as bucking out of the cradle position. I never thought my baby or any baby could be so strong. It was almost like rigid posturing that happens with seizures. Everyone in the house was crying. I really thought we were going to have to go back to the hospital and keep an IV in him and continue to force feed him for then next 2 and 1/2 weeks. Force feeding like that is one of the hardest things I've ever done in my life. I kept hearing from doctors and nurses "You can't hurt them, they will drink eventually". In our case they were wrong, wrong, wrong, wrong! Maybe you can't hurt them physically, but you can hurt them mentally and this can cause physical hurt. We are now changing full diapers and are the happiest people in the world.

About the Authors/Inventors:

My name is Frank Maddin. I write computer games for 3D Realms Entertainment (www.3drealms.com), my last few being Crystal Caves, Monster Bash, and Shadow Warrior (this one is not for children although it does have a parental lock). My wife Lucinda is an operating systems programmer for IBM's AIX. She is taking a year off to care for our son. My email address is fmaddin@bigfoot.com Please feel free to send me email with any problems, questions, comments, improvements, spelling corrections <g>, etc. I would like to thank Joanne of Wide Smiles for her service. I can't believe how much work she has done with the web site.

Dedication:

My parents were separated when I was around 2 but my father was the best dad in the world. He was great at fixing things and I remember thinking at the age of 4 how brilliant he was for fixing my broken toys. But he was not always around to fix things for me and passed away when I was 11, so I was always fixing things myself. This may seem strange, but I would like to give credit to my father for NOT being there all the time for me and my mother for NOT knowing how to fix things. My life could not have been happier if they had, and possibly would not have nurtured the "fix it yourself" attitude that helped me create the Ethan Nipple.