Breastfeeding is important for babies. You probably already know this and you may be worried about how to provide breastmilk now you know your baby has a cleft of the lip and/or palate. The most important thing to know is that even if your baby cannot breastfeed at first, you can still feed your baby your own breastmilk.
Some mothers learn how to breastfeed their baby (who may have any variation of cleft lip and/or hard and soft palate) from birth, or at some stage along the journey, using assisted techniques such as different breastfeeding positions, breast compressions, a breastfeeding supplementer, a nipple shield or a combination of these.
The importance of breastmilk and breastfeeding
When you are in hospital with your baby, there will usually be staff and equipment available to help you express (or pump) milk for your baby. You may need to search for a professional who has experience with breastfeeding babies with clefts. If you are feeling stressed or upset, it may seem easier not to breastfeed or express milk to feed your baby. Family or friends may also think that it will be easier for you to feed your baby formula, but the choice is up to you.
Formula-fed babies have more infections. Babies with a cleft palate can have ear infections more often than other babies, as the Eustachian tubes (that go from the back of the nose to the ear) can fill with milk when they swallow.1 Breastmilk has important immune-protective factors that are not in formula. Protection from infection is also very important for babies who may need surgery.
Breastfeeding promotes optimal face and jaw development. Baby's sucking at the breast exercises her facial muscles.2
Breastfeeding helps bonding. Breastfeeding gives your baby lots of cuddling and skin contact and helps you get to know her. Babies with a cleft often need extra care. Many mothers find breastfeeding their baby helps build a loving and trusting relationship.
Post-surgery benefits: Breastmilk contains lysozyme and epithelial growth factors that help to stop wounds getting infected.3 Many babies are allowed to breastfeed straight after surgery.4 Breastfeeding is comforting for your baby and your soft nipple will not hurt or damage her mouth.
There are many other reasons why breastmilk and breastfeeding are important for you and your baby. An Australian Breastfeeding Association counsellor can give you further information and support as you make your decision.
Babies with a cleft of the lip only can usually breastfeed as a newborn. You can use your breast or fingers to block the cleft to help your baby to get proper suction.
The soft palate may have a cleft. This is often hard to see, so it may only be found after a few hours or days if your baby seems unable to breastfeed. The baby may make a clicking sound while breastfeeding or slip off the breast. The cleft will cause a break in the seal, which is needed for a ‘good’ breastfeeding ‘technique’.
The hard and soft palate may be cleft unilaterally (one side) or bilaterally (both sides). Breastfeeding is most difficult for babies with a cleft of the hard palate. Learning to breastfeed may take a long time and will most likely to require some assisted techniques and/or lactation aids. Your baby will use a lot of energy breastfeeding. He may need more kilojoules so that he keeps growing well. These extra kilojoules could be from expressed breastmilk given by a special cup or feeder.
All babies want to suckle frequently after birth. Your baby does not know he has a cleft and your breast is the perfect soft shape for him to suckle. In time he will learn to fill his cleft with your breast as he becomes better at feeding and you will soon learn how to help him to breastfeed. Even if he is getting most of his milk from a cup or feeding bottle, this practice will exercise his muscles and help him get ready for breastfeeding once the cleft is repaired.
Things to do … breastfeeding your baby
Any time your baby spends at the breast is helpful.
Breast compressions help to increase the flow of milk to your baby.
Comfort sucking and feeding to sleep are important to your baby for both food and learning.
To help form a seal and keep suction, hold your breast in your baby's mouth by pressing with the index and middle finger on the breast, well back from the nipple, making the breast protrude as if full of milk.
Keep your baby's head close to the breast throughout the feeding.
Take each day as it comes. Try not to feel guilty if, at times, breastfeeding is hard work and you feel annoyed or sad. With time it can get easier.
Be flexible and persistent so you can adapt to your baby's changing needs. Knowing how fast babies grow up may help you cope better.
Reward yourself for not giving up and for all your hard work. Allow yourself a treat now and then. You’ve earned it!
Palatal obturator (dental plate)
The use of a palatal obturator (dental plate) varies from country to country and in Australia, from state to state. In Switzerland, the USA and some areas of Australia, the use of such plates from the early days after birth has been shown to help establish breastfeeding in full-term babies with cleft palates.
Made of plastic materials, they are custom-made to fit exactly the shape of the hard and soft palate, extending forward to seal off the nasal cavity from the mouth. The surface should always be completely smooth if correctly made. A rough surface may rub or damage your nipple and areola during breastfeeds.
The plate is made by a paediatric dentist or orthodontist and it is best if it is fitted to your baby in the first 2–3 days of life. The plate will need modifying and/or replacing as your baby grows.
It is common for a baby not to feed well for a day or so after a plate is fitted, as he adjusts to the new shape of his mouth. Careful attention to positioning and attachment may be needed, as your baby learns to take the nipple well into his mouth and press it against the plate.
Some mothers have found a plate more difficult to breastfeed with and take it out for feeds. It is best to keep an open mind and work out what your baby needs.
At some stage, your baby may have a removable, pre-surgical prosthetic device fitted, which is similar to the plate.
Things to remember … when expressing
Most mothers can produce enough milk to meet your baby's needs. The more milk you express, the more you will make. Research has shown that a baby's milk needs do not increase much from 1–6 months of age.5 This means that you will not need to keep increasing the amount of expressed milk as your baby grows bigger. However, you may find your baby needs extra milk after surgery, as she recovers.
Regular expressing is important. You need to keep your supply going by expressing your milk as often as your baby would normally feed.
Expressing during the night is important for your milk supply during the early months.
Consider hiring an electric breast pump, possibly one with a double kit that allows both breasts to be expressed at once. Australian Breastfeeding Association members receive a discount on breast pump hire costs.
Encourage your let-down reflex — by expressing in the same room each time; thinking about or looking at your baby; listening to music or a relaxation tape; practising relaxation exercises for your neck, chest and shoulders; warming the breast pump flange and imagining milk flowing from your breasts.
It is important for your baby to receive as much breastmilk as you can manage to express, even if she is also having some formula. You can increase your milk supply by expressing milk from your breasts more often.
Feeding equipment (used in conjunction with breastfeeding or on its own)
Syringe feeding is often used when the majority of the feeds are done at the breast.
This can often be slow at first, but with experience it can speed up.
See here more information.
Nipple shields can be of use when the baby is struggling to attach or has got used to a bottle teat, and can be used in combination with breast compressions.
The Softplas squeeze bottle manufactured by Douglas Bean (Australia) Pty Ltd comes with a number of feeding spouts and scoops that can be used for cup-feeding.
The Medela Softcup Feeder.
There are several bottles and teats designed for babies with cleft palates. The most common method of feeding is to use a 250 mL polythene squeeze bottle. The teat is placed on your baby's tongue and the flow of milk increased by gently squeezing the bottle. You can pace the squeezes to the rate your baby can drink the milk. However, it is important that baby does not receive the milk too quickly and easily as she needs to learn the suck-swallow-breathe pattern. Trying to drink too fast can make your baby gag, cough and splutter or regurgitate (vomit). 'Working' for the milk will also help your baby to develop her facial muscles and a strong sucking response.
CleftPALS Qld Inc squeeze bottle
The Softplas squeeze bottle manufactured by Douglas Bean (Australia) Pty Ltd
Medela Special Needs (previously called Haberman) Feeder. This is a bottle specially designed for any baby with a poor suck
Pigeon squeezy bottle
Dr Browns Bottle and teat and valve
Pur Simplicity teats, fast flow for 6-18 months
Pigeon cleft palate teat and valve
Using a combination of Chu Chu teat with Pigeon valve
Nuk rubber, fast flow for thick foods, x-cut teats
Nuk feeding spout
As with any bottle-fed baby, you may need to try different teats or spouts to find the one that works best for you and your baby.
Kathryn had a cleft of the soft palate and slightly into the hard palate. I was unable to breastfeed her as she could not make enough suction to milk the breast. I expressed for 12 months. Kathryn was exclusively breastmilk-fed for 7 months, then continued to have breastmilk along with other food until 12 months of age. She was a healthy baby and is a very active, healthy toddler. I found expressing the milk was the easy part, but feeding it to her was hard. We started with a squeezy bottle and a normal teat. We went through over 15 different types of teats but she still couldn't feed properly. We eventually used a Haberman Feeder. It cut feeding times down from 90 minutes to 20–30 minutes. When I wanted to increase my supply I would express more often and I would start to see an increase by day 4. Expressing for my daughter was very rewarding. Sometimes I felt like it was the one positive thing I could do for her. It was particularly good for both of us after her surgery. She had a very fast recovery with no infections and did not need much pain relief.
Rebecca had a cleft of the soft and hard palate diagnosed on day three. I was unaware of assisted breastfeeding techniques and as she had a collapsed lung at birth she struggled to take fifty percent of her bottle, so for the first three months we also used a nasal gastric tube to compliment her feeds until we could see a cleft specialist at three months of age. Weaning her off the nasal gastric tube was challenging and ended up requiring short term medication to stimulate her appetite. At first we used a Haberman feeder, then we trialled the squeeze bottle with the Chu Chu teat and pigeon valve. During this time I expressed four to six times a day with ten minute pumping sessions, the frequency of sessions reflected the number of feeds a normal breastfed baby may have. I was able to keep a strong supply going with the aid of a toddler who was still breastfeeding and some medication. At nine months she had her surgery, which was successfully. Determined not to give her another bottle and to get her on the breast, I spoon fed her liquid and purees the first four weeks, we then used a supply line and nipple shield for the next five weeks until one evening she proved that could breastfeed unassisted. All up I expressed for my daughter for eleven months. At thirteen months of age the breastfeeding is still going well and it is such a joy, and such a delight and time saver no longer having to pump.
Other issues that may happen
Many babies with clefts, whether breastfed, breastmilk-fed or fed with formula, have wind or colic problems, because they swallow more air than other babies.
These ideas may help:
feed in an upright position
burp baby often during feeding
carry baby upright in a sling
massage your baby.
Regurgitation or vomiting of milk (or solid foods in later months) through the nose of a baby with a cleft palate is fairly common. It will stop once the palate is repaired. Breastmilk will not hurt the lining of your baby's nose.
Your child health nurse, lactation consultant and your Australian Breastfeeding Association counsellor will all be able to provide you with information and support as you breastfeed and/or express. They may be able to put you in contact with another mother of a baby who has had a cleft or refer you to the CleftPALS organisation. However you decide to feed your baby, there is support available to help you.
More information is available in the Australian Breastfeeding Association booklet Breastfeeding: babies with a cleft of lip and/or palate. Please contact the Australian Breastfeeding Association by calling 03 9885 0855 or emailing: firstname.lastname@example.org for further details about our books and booklets.
Support organisation: CleftPALS stands for Cleft Palate and Lip Society. CleftPALS is a national organisation of parents and professionals involved in the treatment of the cleft condition. Volunteers from CleftPALS offer support and guidance to new families all over Australia. The association produces a newsletter and provides ongoing information and support. There are several CleftPALS branches around Australia, including in NSW, WA, QLD and VIC (the Victorian branch covers Tasmania and South Australia too).
The Royal Children’s Hospital Melbourne VIC website also has helpful information. See The Royal Children’s Hospital Cleft Lip and Palate booklet and also some factsheets on clefts can be found here under ‘c’.
The Children's Hospital at Westmead NSW website also has helpful information.
Give us a little time: How babies with a cleft lip or cleft palate can be breastfed published by Medela AG, Switzerland, 1996. Can be ordered through: www.medela.com. It goes with the Christa Hertzog-Isler video Breastfeeding Infants With Cleft Lip & Cleft Palate.
1. Aniansson, G., Svensson H., Becker, M., Ingvarsson, L. 2002, Otitis media and feeding with breast milk of children with cleft palate. Scand J Plast Reconstr Surg Hand Surg 36(1):9–15.
2. Gomes, C., Trezza, E., Murade, E., Padovani, C. 2006, Surface electromyography of facial muscles during natural and artificial feeding of infants. J Pediatr (Rio J) 82(2):103–109.
Raymond, J., Bacon, W. 2006, Influence of feeding method on maxillofacial development. Orthod Fr 77(1):101–103.
3. Shah, P., Aliwalas, L, Shah, V. 2007, Breastfeeding or breastmilk to alleviate procedural pain in neonates: a systematic review. Breastfeeding Med 2(2):74–82.
4. Darzi, M., Chowdri, M., Bhat, A. 1996, Breast feeding or spoon feeding after cleft lip repair: a prospective randomised study. Br J Plast Surg 49:24–26
Cohen, M., Marschall, M., Schafer, M. 1992, Immediate unrestricted feeding of infants following cleft lip and palate repairs. J Craniofac Surg 3(1):30–32.
5. Kent, J.C., Leon, M.R., Cregan, M.D., Ramsay, D.T., Doherty, D.A., Hartmann, P.E. 2006, Volume and frequency of breastfeeding and fat content of breastmilk throughout the day. Pediatrics 117(3):e387–e395.
© Australian Breastfeeding Association Reviewed September 2015