Cleft lip and/or palate - feeding your baby

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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Sucking is an important skill babies need to feed well.  When a baby is born with a cleft lip and/or palate it is often difficult for the baby to suck milk from the breast or bottle.  With some adjustments to feeding methods and positioning, your baby should be able to get all the benefits of the feeding experience, e.g. enough nutrition for growth and development, bonding with carer and use of the muscles of the mouth.

Babies with a cleft lip

Babies born with a cleft lip don't usually experience feeding difficulties. In most cases, your baby will still be able to breastfeed. See the section on breast milk and breast feeding  for more information.

Babies with a cleft of the soft palate only

If your baby's cleft is narrow and limited to the soft palate, he or she may be able to feed from the breast.  In some cases they may need supplementary feeds from a bottle with either expressed breast milk or formula.

Babies with a cleft of the lip and the soft and hard palate

In most cases, these babies are unable to breastfeed. This is because they do not have an adequate palate that separates the nose from the mouth, making it difficult to create enough pressure in the mouth to draw milk from the breast. These babies usually feed successfully with bottles and teats specifically designed for babies with clefts.

You can always try to breastfeed, but remember that the important issues are that your baby has adequate nutrition, gains weight and is content. If breast-feeding is not achieving these outcomes, then it may be necessary to bottle feed as well.  Your baby may start their feed at the breast, and complete the feed using a bottle of formula or expressed milk. This combination of feeding methods often provides the best nutrition.

Babies with a Cleft palate:

  • May have nasal regurgitation (milk coming out through the nose) during feeding. Gently wipe the milk away.
  • May need a longer time to finish a feed (active feeding time may be up to 45 minutes in the first month (active feeding time refers to actual feeding time as distinct from burping, nappy changes etc).
  • May need to be burped more often (at least 2-3 times during a feed).

Feeding methods

As discussed above, breastfeeding, bottle-feeding or a combination of the two may be chosen, depending on your baby's cleft condition. 

Breast milk and breastfeeding

Current research findings indicate that breast milk is best for babies.

Even though breastfeeding may be difficult for a baby with a cleft palate, there is the option of the mother expressing her milk and giving it to her baby via the bottle. Many mothers of babies who have cleft palates and have not been able to breastfeed opt for this method.

A baby with a cleft of the lip only might successfully breastfeed with some modification in positioning. If the cleft is on one side, positioning your baby with the cleft towards the breast may be helpful. This allows for the cleft to be tucked into the breast tissue and makes it easier for your baby to attach, reducing the amount of air sucked in whilst feeding.

Use of the “football” breastfeeding position can be helpful in positioning the cleft lip toward the breast (see photograph below).

Keeping your baby as upright as possible during feeding will allow the milk to flow down into your baby's stomach easily and help prevent choking. It may also stop milk from going into the nose and the ear canals.

Breastfeeding will be more difficult for babies who have a cleft on both sides of the lip. This is because they may have more difficulty forming an airtight seal around the nipple.

For most babies with a cleft palate, breastfeeding as the only feeding method is not successful in providing enough nutrition for growth. This is because of the cleft and difficulties drawing milk from the breast.

If breastfeeding is chosen, here are some things to consider:

  • When breastfeeding an infant with a complete cleft lip/palate, extra effort is needed to maintain milk supply because these babies tend to have weak sucking skills and difficulty emptying the breasts. Ideally mothers should express every 3 hours after feeds in order to establish and maintain their milk supply
  • Most of these babies will require supplementary feeds via a squeeze bottle, so it is important to express milk immediately after each feed, to maintain an adequate milk supply and to ensure milk is available for the bottle feed. This can be done by hand or with a manual or electric breast pump.
  • At the beginning of the feed, latch your baby onto the breast and "milk" the breast surrounding the areola area by applying gentle pressure with the fingers and squeezing toward the areola. This may help compensate for the lack of suction.
  • Breastfeeding can be time-consuming, especially when the time taken to express milk between feeds is factored in. For some mothers, it may be impractical; especially when there are other children to care for.

Bottle-feeding

There is a choice of bottles and teats available for babies with cleft conditions. The bottles are made of soft, squeezable plastic. The teats are specially designed to help your baby draw milk from the bottle even with very little pressure from the tongue against the teat.

The Speech Pathologist or Clinical Nurse Consultant at your Cleft Palate Clinic will be able to advise you on the most suitable type of bottle and teat to use for your baby.  They can also provide you with information about where you can purchase these products.

Alternatively, information about purchasing bottles and teats can be found on the fact sheet: “Cleft palate feeding bottles and teats.”

If your baby is able to feed effectively with a standard teat and bottle available from supermarkets or chemists, there is no need to use any special equipment.

Feeding Techniques using a squeeze bottle:

When you first get a squeeze bottle, it is a good idea to practise squeezing a water-filled bottle over a sink before feeding. This will give you some idea about how firmly and frequently the bottle needs to be squeezed to get a steady flow of milk.

Establish a rhythm of squeezing the bottle just after your baby suckles. Allow your baby to swallow the milk before squeezing again.

Some further information

  • There is no particular formula designed for babies with cleft conditions. If in doubt about the most suitable one, consult a child and family health nurse, GP or paediatrician.
  • Clean the area around the cleft thoroughly after each feed with a cotton bud and sterile water. 
  • Sterilise the squeeze bottles and teats in solution for no longer than one hour. Remove and store in a sterile container between use. Prolonged sterilisation causes the bottles to perish more quickly.
  • If your baby is fitted with a plate and there are concerns about feeding, talk to the Orthodontist and Speech Pathologist on the Cleft Palate team. 
  • Babies with cleft conditions :
  • Develop their feeding skills in the same way and at the same times as other babies. For example, solids are introduced at the same age i.e. from around 6 months of age.
  • Should gain weight at similar rates to other babies without cleft conditions. 
  • Should not cough and choke at every feed.  If this happens, please consult the Speech Pathologist at your Cleft Palate Clinic.

Breastfeeding after your baby has had surgery

If your baby has had some success breastfeeding up until the time of surgery, he or she is likely to be able to breastfeed following surgery.

Breastfeeding immediately following surgery should be discussed with the managing surgeon.

If your baby has not been breastfed prior to surgery, breast-feeding may be difficult to establish following surgery.  Ways to maximise the chance of your baby successfully breast-feeding following surgery can be discussed with the child and family health nurse, Speech Pathologist and Lactation Consultant.

Remember

  • Babies with a cleft take longer to feed, especially in the first month.

  • Get familiar with using a squeeze bottle before starting to feed your baby.

  • Keep your baby in an upright position during feeds.

  • Babies with cleft conditions develop their feeding skills in the same way and at the same times as other babies.

  • Babies with cleft conditions should gain weight at a similar rate to other babies

  • Babies with cleft conditions should not cough and choke during feeding.

  • If you have concerns about feeding, contact the Speech Pathologist at your Cleft Palate Clinic for advice.

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Kids Health (CHW)
The Children's Hospital at Westmead
Tel: (02) 9845 0000
Fax: (02) 9845 3562
www.chw.edu.au
Sydney Children's Hospital, Randwick
Sydney Children's Hospital, Randwick
Tel: (02) 9382 1688
Fax: (02) 9382 1451
www.sch.edu.au
Kaleidoscope, Hunter Children's Health Network
Kaleidoscope Children Young People and Families Network
Tel: (02) 4921 3670
Fax: (02) 4921 3599
www.kaleidoscope.org.au