Chapter 7: Feeding Babies Born with Cleft Lip and/or Palate

Babies born with cleft lip and/or palate may find it difficult to breastfeed or bottle-feed. Because there is no separation between the nose and the mouth, babies may have difficulty creating the suction needed to feed in these ways. This is also one of the reasons why the liquid may come out through the baby's nose during or just after a feed. The lips are also important in feeding as they form a good seal around the nipple or teat, so preventing milk being lost out of the mouth.

Breastfeeding and cleft lip/palate

Breastfeeding is an option for babies with a mild cleft lip or a small cleft of the soft palate. It is more difficult when there is a wide cleft (one centimetre or more) or a bilateral (both sides) cleft. In these cases, sucking will be difficult.

You can always try to breastfeed, but remember that, soon after birth, the important issue is that your baby has adequate nutrition and gains weight. If this is not happening with breast-feeding, then it may be necessary to go on to bottle feeds. Some babies start their feed on the breast, and complete the feed with a bottle. A combination of feeding methods, like this, often provides the best nutrition.

Positioning during breast-feeding is important. If the cleft is on one side, it may help to place your baby with the cleft side towards your body. 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. A more upright position 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.

If your baby's cleft is narrow and limited to the soft palate, he/she may be able to use the front part of the hard palate to suckle the nipple. For many, breastfeeding as the only feeding method is not successful in providing enough nutrition for growth.

Feeding may take quite a lot longer for these babies as it is a considerable effort for them (and you) to get enough milk to satisfy them before they tire. They also tend to take in more air while feeding and, therefore, they need to be burped regularly.

Stimulating the 'let down' of milk at the start of the feed is important for maintaining milk supply. Expressing a little milk just before your baby latches on to the breast will help encourage your baby to keep sucking. Putting the nipple into the baby's mouth and 'milking' the surrounding area may help breastfeeding by compensating for the lack of suction. Some mothers feel that supplying breast milk for their babies is an important way of contributing to their baby's care. This is an individual choice.

Bottle-feeding and cleft lip/palate

If and when the decision is made to bottle-feed your baby, there are special bottles and teats available that will help your baby suck more effectively. In most cases, the preferred choice is a soft squeeze bottle and Chu-Chu cleft palate teat. They are suitable for both expressed breast milk and formulas.

Most squeeze bottles, including the Cleft PALS and Softplas bottles are soft but need to be squeezed firmly as the baby feeds. When feeding with the squeeze bottle, let the baby suck as much as possible as this encourages a strong suck, but help by squeezing the bottle gently as the baby sucks. Try to follow the rhythm of the baby's jaw movement with your squeezing. If your baby vomits during feeding, you may be squeezing the bottle a little too hard or too often. If vomiting persists, contact your paediatrician or family doctor.

An important part of the feeding process is positioning. Make sure your baby is positioned as upright as possible. This will help decrease the amount of liquid going up through the nose and into the ear canals. Because your baby is swallowing more air during sucking, burping your baby regularly during feeding will reduce discomfort.

Solids and cleft lip/palate

Children with cleft conditions have the same nutritional needs as other children. Consequently, strained foods should be introduced at the appropriate age, usually around 4-6 months. For further information, please contact your Baby Health Clinic Sister or the dietitian at your local children's hospital.

Some problems with solids may occur if introduced before the palate is closed. As with liquids, food may find its way into the nose. A little drink after the solids may clear any food caught in the nose. Most children will quickly adapt and learn to stop the food going up into the nose. Remember to give only small amounts of food at a time and stay away from foods that may irritate the nasal passages. You will soon learn to know the foods which have this reaction on your child. Some children may not manage solids well until after the palate has been repaired. In these cases, it is important that you remain calm and patient and always consult your doctor if you are concerned.

Feeding at the time of the lip operation

If your baby is interested in breast-feeding, and has had some success in breast-feeding up until the time of surgery, it is likely that this method of feeding will continue. Discuss this with the managing surgeon.

If bottle-feeding, you may be told that it is advisable not to use a teat for a few days. This is so that the stitches in the lip do not come undone. In hospital, your baby will usually be fed with either a dropper, a syringe or a special spout attachment on a bottle. Do not worry about this change of feeding method as most babies seem to cope. It is important to check with your surgeon about what is and is not allowed after the operation.

Feeding at time of the palate operation

At the time of the palate operation, nothing hard is allowed to be put in the mouth and so, bottle-feeding is not possible. Once again, this is to avoid disturbing the stitches. A feeding cup with a small spout can be used. Sometimes, a spout or scoop attachment is put on a squeeze bottle which rests on the lips during the feeds but does not go into the mouth. Some babies, by this time, are taking food off a spoon, and this is allowed, as long as the person feeding the baby is careful and the spoon does not have sharp edges.

Remember, if at any time you are worried about feeding, contact your Doctor or Speech Pathologist.

Further Information

To obtain further information on "Cleft Lip and Palate: A Parent's Guide", please contact Belinda Liston:

Jill Barbuto
Cleft Palate Clinic Coordinator
The Cleft Palate Clinic
The Children's Hospital at Westmead
Locked Bag 4001
WESTMEAD NSW 2145
AUSTRALIA
T: + 61 2 9845 2079
F: + 61 2 9845 2078
E: Jill.barbuto@health.nsw.gov.au