What Is Nasoalveolar Molding (NAM)? Does It Hurt?
At a Glance
Nasoalveolar Molding (NAM) is a custom-fitted device worn by infants to narrow the cleft lip gap and shape the nose before surgery. It uses gentle, painless pressure to guide natural growth. While babies adjust quickly, NAM requires daily caregiver maintenance and frequent clinic visits.
In this answer
4 sections
When preparing for a cleft lip repair, your doctor may recommend a Nasoalveolar Molding (NAM) device. A NAM device is a custom-fitted acrylic plate that is worn much like a retainer. It gently guides the growth of the baby’s gums, narrows the gap in the cleft, and shapes the nose cartilage leading up to the primary lip repair surgery [1][2]. While the device may look intimidating, parents can be reassured that NAM is generally very well-tolerated by babies. Because it applies only continuous, gentle pressure, babies typically adjust to wearing it within a few days [3].
How Does NAM Work?
The NAM process usually begins shortly after birth and is typically worn for 3 to 5 months, right up until the time of the primary lip repair surgery [4]. The care team creates a mold of the baby’s mouth to make the custom acrylic plate. As the baby grows, an orthodontist or cleft specialist will make minor weekly adjustments to the device to continue guiding the tissues [5].
- Closing the Gap: By applying slow, gentle pressure, the NAM device guides the bone and soft tissue of the gums (the alveolar segments) closer together [3].
- Shaping the Nose: Once the gap is narrowed, a small wire with a soft, rounded nasal stent may be added to gently lift and shape the cartilage of the baby’s nose [1].
- Tape and Elastics: Small pieces of specialized medical tape and gentle elastics are used on the baby’s cheeks to help hold the device in place and gently stretch the lip muscles downward [6].
How NAM Helps with Surgery
The goal of NAM is to make the primary lip and nose repair surgery easier and more successful for the baby [7][8]. By taking advantage of the flexibility of a newborn’s cartilage, NAM offers several significant benefits:
- Smaller Surgical Gap: Narrowing the cleft means the surgeon does not have to stretch the baby’s tissues as much during the repair, which reduces tension on the surgical incision [9].
- Better Aesthetics: Studies show that bringing the tissues closer together and shaping the nose ahead of time improves nasal symmetry and overall aesthetic outcomes [10][11].
- Fewer Future Surgeries: Infants who use a NAM device may require fewer revision surgeries—such as secondary nasal surgeries—as they grow older [11][12].
- Safe for Long-Term Growth: Research confirms that NAM does not negatively affect the long-term growth of the midface or jaw [13][14].
Does It Hurt the Baby?
Parents naturally worry about their baby being in pain. While no parent wants to see their child uncomfortable, the NAM device operates on the same principle as braces for older children. Because a baby’s tissues are incredibly soft and flexible, it simply guides natural growth [3].
- The Adjustment Period: Just like getting used to a new pacifier, it usually takes a few days for the baby to adjust to the feeling of the device in their mouth [15]. During this brief time, they may be a bit fussy due to the new sensation.
- Skin and Tissue Care: The main source of temporary discomfort with NAM is usually related to pulling medical tape off the cheeks or mild rubbing against the gums [6]. Your care team will show you how to safely clean the device, monitor for small sores, and apply or remove the tape gently to protect the baby’s delicate skin [5].
What to Expect for Caregivers
It is important to know that NAM therapy requires a significant time and emotional commitment from parents and caregivers [5][16].
- Daily Wear and Feeding: The NAM device is typically worn 24 hours a day, including during sleep and feeding. If your baby also has a cleft palate (an opening in the roof of the mouth), the NAM device covers this opening, which can actually make bottle-feeding easier [17]. You will likely still need specialized cleft bottles, which your feeding specialist will help you navigate.
- Daily Maintenance: Parents are responsible for cleaning the device daily and replacing the cheek tapes and elastics, which can be stressful at first with a squirming newborn.
- Frequent Appointments: You will need to bring your baby to the clinic frequently—often every 1 to 2 weeks for months—so the specialist can adjust the device as the baby grows [5].
Common questions in this guide
What is a NAM device?
Does wearing a NAM device hurt my baby?
How long does a baby need to wear the NAM device?
Can my baby still eat while wearing a NAM device?
How often will the NAM device need to be adjusted?
Questions to Ask Your Doctor
Curated prompts to bring to your next appointment.
- 1.How frequently will we need to visit the clinic for adjustments to the NAM device?
- 2.What specific signs of skin irritation or gum sores should prompt us to contact you between visits?
- 3.Who can we contact after hours if we have trouble with the tape or the device slipping?
- 4.Can you connect us with a feeding specialist to help us choose the right cleft bottles to use with the NAM device?
- 5.Based on the size of the cleft, how many weeks or months do you estimate my baby will need to wear the NAM device before surgery?
Questions For You
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References
References (17)
- 1
The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty.
Siriwiroj S, Pisek P, Punyavong P, et al.
The Journal of craniofacial surgery 2024; (35(2)):412-414 doi:10.1097/SCS.0000000000009872.
PMID: 37983067 - 2
Controversies in the Management of Patients with Cleft Lip and Palate.
Rodman RE, Tatum S
Facial plastic surgery clinics of North America 2016; (24(3)):255-64.
PMID: 27400840 - 3
Effectiveness of Presurgical Nasoalveolar Molding Appliance in Infants With Complete Unilateral Cleft Lip and Palate.
Dinh TTN, Van Nguyen D, Dien VHA, Dong TK
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2022; (59(8)):995-1000 doi:10.1177/10556656211026493.
PMID: 34164995 - 4
Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity.
Kinouchi N, Horiuchi S, Yasue A, et al.
Saudi medical journal 2018; (39(2)):169-178 doi:10.15537/smj.2018.2.21020.
PMID: 29436566 - 5
The Burden of Care of Nasoalveolar Molding: An Institutional Experience.
Alfonso AR, Park JJ, Kalra A, et al.
The Journal of craniofacial surgery 2024; (35(2)):602-607 doi:10.1097/SCS.0000000000009960.
PMID: 38231199 - 6
Complications During Grayson Presurgical Nasoalveolar Molding Method in Nonsyndromic Infants With Complete Unilateral Cleft Lip and Palate.
Garcés Alvear GA, Moreno Soza MIB, Ormeño Quintana ADP, Gutiérrez Melis CM
The Journal of craniofacial surgery 2021; (32(6)):2159-2162 doi:10.1097/SCS.0000000000007532.
PMID: 34516070 - 7
A Comprehensive Clinical Perspective of Nasoalveolar Molding (NAM) for the Treatment of Cleft Lip and Palate patients.
Ali AAA
Journal of clinical and experimental dentistry 2025; (17(5)):e552-e559 doi:10.4317/jced.62575.
PMID: 40485962 - 8
Presurgical management trends and nasoalveolar molding usage for infants with cleft lip and palate in the capital of a developing country.
Al-Lami HA, Al-Rudainy D, Mohammed-Salih HS, Salman SM
Journal of orthodontic science 2024; (13()):4 doi:10.4103/jos.jos_165_23.
PMID: 38516115 - 9
Three-dimensional Changes of Maxillary Alveolar Morphology After Using Modified Nasoalveolar Molding in Patients with Complete Unilateral Cleft lip and Palate.
Chaisooktaksin N, Chimruang J, Worasakwutiphong S, Tansalarak R
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2023; (60(8)):928-937 doi:10.1177/10556656221086816.
PMID: 35285744 - 10
Enhancing Surgical Outcomes: Presurgical Nasoalveolar Molding for Unilateral Cleft Lip, Alveolus, and Palate in Infants-A Progressive Clinical Report.
Yadav L, Mattu N, Yadav N, Deo JK
International journal of clinical pediatric dentistry 2024; (17(8)):951-954 doi:10.5005/jp-journals-10005-2916.
PMID: 39372343 - 11
Long-Term Comparison of the Aesthetic Outcomes between Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Patients with Unilateral Cleft Lip and Palate.
Nayak T, Bonanthaya K, Parmar R, Shetty PN
Plastic and reconstructive surgery 2021; (148(5)):775e-784e doi:10.1097/PRS.0000000000008463.
PMID: 34705782 - 12
Effect of One-Stage Bilateral Cleft Lip, Nose, and Alveolus Repair Following Nasoalveolar Molding on the Premaxilla Position at Preadolescence: An 8-Year Retrospective Study.
Traube IM, Cutting CB, Grayson BH, Shetye PR
The Journal of craniofacial surgery 2023; (34(1)):198-201 doi:10.1097/SCS.0000000000007976.
PMID: 34260466 - 13
Effects of Computer-Aided Design-Nasoalveolar Molding on Midface Growth in Patients With Complete Bilateral Cleft Lip and Palate at 8 Years of Age.
Gong X, Dang R, Yang C, Yu Q
The Journal of craniofacial surgery 2025; doi:10.1097/SCS.0000000000011878.
PMID: 40905575 - 14
Effect of Nasoalveolar Molding on Skeletal Growth in Individuals With Bilateral Cleft Lip and Palate During the Mixed Dentition Stage.
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The Journal of craniofacial surgery 2026; doi:10.1097/SCS.0000000000012477.
PMID: 41603919 - 15
Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial.
Kalaskar R, Bhaje P, Sharma P, et al.
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PMID: 34462383 - 16
Assessing Burden of Care in the Patient With Cleft Lip and Palate: Factors Influencing Completion and Noncompletion of Nasoalveolar Molding.
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This page provides educational information about Nasoalveolar Molding (NAM) for infants. Always consult your cleft care team or pediatric orthodontist for specific medical advice regarding your baby's care.
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