Breastfeeding babies with clefts of lip and/or palate

Breastfeeding and breastmilk are important for babies. You probably already know this and you may be worried about how to provide breastmilk if 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. Cleft booklet

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. 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 artificial milks, but breastmilk and breastfeeding are very important for your baby, both now and in the future. 

Artificially-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. Breastmilk has important immune system factors that are not in artificial milk formulas. Protection from infection is also very important for babies who may need surgery.

Breastmilk is a natural fluid. It will not hurt the delicate lining of your baby's nose. Milk can leak into the nose while baby is feeding when she has a cleft of the hard and/or soft palate. Breastmilk is also less harmful than artificial baby milk if aspirated (taken into the lungs). This is common in babies who have feeding difficulties.

Breastfeeding promotes optimal face and jaw development. Baby's sucking at the breast exercises her facial muscles. It also helps her future speech development.

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 factor that help to stop wounds getting infected. Many babies are allowed to breastfeed straight after surgery. 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.

Breastfeeding

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 'click' or slip off the breast. The cleft will cause a break in the seal, which is needed for breastfeeding.

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. 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 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.
  • 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.

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

  • Your body 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. 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 subscribers 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; 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 artificial baby milk. You can increase your milk supply by expressing milk from your breasts more often.

Feeding equipment

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 develop her facial muscles and a strong sucking response.

The most common types of feeding equipment are:

Cups

  • 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.

Bottles

  • 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. (Available from Mothers Direct or other Medela stockists.)
  • Pigeon squeezy bottle.

Teats

  • Pigeon cleft palate teat
  • Nuk rubber, fast flow for thick foods, x-cut teats
  • Nuk feeding spout
  • Pur Simplicity teats, fast flow for 6-18 months

For up-to-date information regarding the above products and their availability, contact CleftPALS.

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 11/2 hours to 20-30 minutes. The most I ever managed to express in 24 hours was 1450 mL. 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. 

Other issues that may happen

Many babies with clefts, whether breastfed, breastmilk-fed or fed with artificial baby milk, have wind or colic problems, because they swallow more air than other babies

These ideas may help:

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.

Further resources

More information is available in the Australian Breastfeeding Association booklet Breastfeeding: babies with a cleft of lip and/or palate.

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. They have contact parents who can visit you while you are still in hospital or once you get home. 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 health professionals or www.medela.com. It goes with the Christa Hertzog-Isler video Breastfeeding Infants With Cleft Lip & Cleft Palate.

The Australian Breastfeeding Association Lactation Resource Centre has articles and case histories on babies with cleft of lip and/or palate. To contact the Lactation Resource Centre, phone the Australian Breastfeeding Association's Head Office on (03) 9885 0855.

The following resources are available from Mothers Direct:

ABA Booklets:

Breastfeeding: an introduction
Breastfeeding: breast and nipple Care
Breastfeeding and hospitalisation
Breastfeeding: expressing and storing breastmilk
Increasing Your Supply
Postnatal Depression and Breastfeeding
Breastfeeding: relactation and adoption
Breastfeeding: diet, exercise, sex and more
Why Is My Baby Crying?
Breastfeeding: as your family grows

Books:

Breastfeeding ... naturally (3rd edition) Australian Breastfeeding Association

Mothers Direct products:

Baby slings: Simplicity Sling, Cool Sling, Meh Tai and others
Hand Expressing and Cup Feeding (video)
Medela Softcup Feeder
Medela Special Needs Feeder (previously Haberman Feeder)
Medela Supplemental Nursing System (breastmilk supplementer)
Expressed milk storage bags
Sensible Lines Milk Trays (storage trays that freeze milk in 30 mL sticks that will fit into a bottle)
Infant care lambskins
Range of breast pumps, manual and electric
Other lactation aids
A range of books and baby-care products

© Australian Breastfeeding Association Reviewed October 2012