Tips, tricks and advice for using the NAM

If you’re reading this, chances are high that you already know what the NAM is. If you don’t know, it is a Nasoalveolar device (commonly referred to as the NAM) that is used to prepare a cleft child for surgery.

It helps pull the cleft together so that surgeons can get a better result. Because surgeons can often get such great results because of the NAM, it can also help decrease the number of reconstructive surgeries a cleft child may need.

My son Wyatt was born with a bilateral cleft lip and palate and he was able to get his NAM when he was 6 weeks old. Typically it’s done sooner, but we were a little behind because of an insurance snafu.

You can read about the beginning of our cleft journey here.

The NAM is an amazing tool BUT it isn’t a walk in the park! It’s a lot of work and it takes time, work, dedication and a lot of patience.

I’ve put together a list of things I learned along the way in hopes that it can help other parents.

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NAM tips and tricks

• Cleaning and prepping is tough and you’ll probably hate it long before you’re close to ending your NAM journey. Prepare all the tape and bands ahead of time to save yourself a lot of frustration.
  • If possible, ask a family member to do this for you. People will probably be asking you what they can do to help during this time, so give them something useful to do!
• Make sure to take a picture of your baby’s cleft right before they start using the NAM. Then continue to take pictures during the whole treatment and make sure they are time stamped. It really helped me to do a side-by-side comparison on a photo app so I could see his amazing progress.

• Before you put the NAM in the mouth, you will need to dry the inside of the mouth using Sterile Squares. The NAM won’t stick if the mouth is too wet.
• You will be using Polident or something similar to “glue” the NAM to the roof of the mouth. Keep your Polident in the fridge – it helps it stick better.
• You only need to use a thin line of the Polident. Put it in, press firmly, and try to hold it in there for about a minute.
• Do not rush when putting the NAM in. You will regret it EVERY SINGLE TIME! If you rush it, it will fall right back out 100% of the time. Then you will cry. And then your baby will cry. Ok, ok, just because I cried doesn’t mean you will lol.
• If you get frustrated while trying to get it in, take a break for a little bit if you can. For some reason, the NAM knows when you’re about to lose it and it will not stay in.
• Keep a little baggie of NAM supplies in your diaper bag just in case it falls out and you are away from home for several hours.
• It should be taken out and cleaned twice a day. So you will clean it once in the morning and again before bedtime.
• To clean it, gently take it out and then run it under cool water. I would then clean it with a little bit of toothpaste and a small toothbrush.
  • Make sure to dry it completely before putting it back in.
  • Clean the inside of the mouth. It is important to get all of the adhesive off. I used damp sterile squares and also Cotton Tip Applicators (basically large q-tips).
• The tape will often get really damp during the day from milk and drool, so you’ll need to replace it. You DO NOT need to take the device out to do this. Just replace the tape.
• If the NAM is ever missing, it’s usually in the bassinet or the car seat.
• The first few days may be rough while your baby adjusts. Make sure you have Infant Tylenol on hand.
• You will typically need to go in weekly for adjustments to be made. If you live far from their office, ask if they will allow you to do adjustments every 2 weeks instead. Our Orthodontist did this for us and it was really helpful.
• The cheeks can get irritated from all the taping. Make sure to put Aquaphor on the rash at the first sign of irritation. I was advised by my doctor to remove the tape and leave the NAM out while the rash healed. Please make sure to check with your doctor to see what they want you to do in this situation.
• Occasionally after an adjustment is made you may notice that your baby is really unhappy. If it doesn’t go away, it’s possible that some rough patches on the NAM need to be smoothed out and are causing irritation. Just call your Orthodontists office and go back in to have it adjusted.
• If your baby suddenly stops tolerating the NAM, check for teething. This happened to my son when he started developing a top tooth. Because of this, we decided to discontinue treatment because he seemed to be in a lot of pain.

Supplies

All of the supplies that I used were supplied by our Doctor. This seems to be the norm but I have seen many moms post on social media that they have to purchase all the NAM supplies themselves. In case you need to purchase them, I’ve made a little list of what I used.

• Sterile Squares: Used for drying the inside of the mouth.
• Cotton Tip Applicators: Used to clean the gums.
• 3M Steri Strips 1/4×4″: Tape. Make sure to double-check with your doctor that this is the appropriate size for your baby. Be sure to stock up on these – you will need A LOT of them!
• 3M Tegaderm: This is used on the cheeks to try to prevent skin irritation from the tape. It is what the tape is attached to. You can see it in the picture below.
• 3/16″ Rubber Bands: These are used with the tape to secure the NAM. Please check with your doctor first to make sure this is the appropriate size.

One great product to have on hand is a Nose Frida (whether you do the NAM or not). I know the concept of this is really gross, but this is something you will need for your cleft affected child. It will be so helpful to you when your baby is congested, which will happen A LOT!

It WILL NOT get into your mouth:) It will all stay in the plastic tube. I know this is a common fear, but it’s not anything you need to worry about.

I hope this was helpful to you! Please leave me a comment or message me if you have additional questions or if there’s anything you think I should add to this list. And don’t forget to join a support group! They are a goldmine of info!

P.S. Check out these sweet #CLEFTSTRONG ornaments!

You may also like reading these other posts about our cleft journey:

Our cleft story: The beginning

Tips every new cleft parent needs to know

Our cleft repair journey: The NAM device