Cleft Lip/Cleft Palate: Feeding Your Child

When a baby is born with a cleft, it's important to help the baby feed well to prevent dehydration and make sure they gain weight. Babies born with a cleft may need some special feeding help.

How Can I Feed My Baby With a Cleft Lip?

Most babies born with a cleft lip (and no cleft palate) feed well without any special equipment. They usually can breastfeed or use a regular bottle-feeding system.

The only change needed might be positioning the nipple so the baby can latch. If you're breastfeeding your baby, try changing the feeding position so that your breast fills the cleft.

What Are the Challenges of Feeding a Baby With a Cleft Palate?

Babies born with a cleft palate, whether with a cleft lip or without, can't breastfeed. That's because they can't create the pressure needed to suck milk from the nipple. Trying to breastfeed or use a regular bottle system to feed a baby with a cleft palate can lead to poor weight gain and failure to thrive.

Other challenges include:

• Liquid may leak out of the baby's nose (called nasal regurgitation).
• The baby may swallow more air while feeding.
• Babies who have a may have other feeding and digestive challenges.

What Bottle Should I Use to Feed a Baby With a Cleft Palate?

Babies with a cleft palate need to be fed with a specialty bottle system. It provides the proper nutrition without the need for pressure while sucking.

Cleft feeding bottle systems include:

Dr. Brown's Specialty Feeding System

This bottle system has a one-way feeding valve that prevents milk from flowing back into the bottle. This lets the baby bite down on the nipple to get the milk without sucking. Different nipple flow rates vary based on the baby's age (from preemie to level 3).

This bottle system often is the easiest for parents and caregivers. The baby does all the work and there's no need for special positioning.

Pigeon Feeder

This bottle system also has a one-way valve to keep milk from going back into the bottle. The Y-cut nipple is thinner on one side and thicker on the other:

• The thicker side is placed along the baby's upper gum.
• The thinner side goes on the baby's tongue.
• The small notch under the rim of the nipple goes under the baby's nose. 

The nipple comes in two sizes. You also can adjust the flow rate by tightening or loosening the nipple.

Medela SpecialNeeds Feeder (Haberman)

This bottle system also has a one-way valve to keep milk in the nipple. Some babies can push the nipple against their gum to get the milk. But usually, a caregiver needs to squeeze the bottle to match the baby's sucking and swallowing pace:

• As the baby begins to suck, squeeze the bottle, then relax. 
• Continue to do this only when the baby is sucking. Listen for the sound of your baby swallowing. If the baby pauses to breathe, you should also pause.

Getting the timing right can take a few tries. Three lines along the bottle show the nipple flow rate. Turn the bottle so one of the lines is under the baby's nose to adjust the flow rate.

Enfamil Mead Johnson Cleft Lip/Palate Nurser

This bottle does not have a one-way valve. As with the Haberman bottle system, the caregiver must squeeze and time their pace to match the baby's sucking pattern.

What Other Tips Can Help?

• Feedings should take less than 30 minutes. If they take longer, try a faster flow nipple.
• Burp your baby often, about every 5 minutes during the feed.
• Keep your baby upright during the feeding and for 20–30 minutes after to limit nasal regurgitation. If milk leaks out of your baby's nose, wipe it away with a clean cloth. You do not need to use a suction bulb.
• Though babies with a cleft palate can't breastfeed, moms can feed them breast milk in the bottle. They also can do non-nutritive sucking to further bond with their babies. This is when a baby sucks at the breast for comfort, not for feeding. Limit your baby's non-nutritive sucking to less than 10 minutes per feed.

How Can I Tell if My Baby Isn't Feeding Well?

Feeding challenges put babies with a cleft palate at risk for failure to thrive. Regular weight checks by your baby's doctor or the cleft team can help make sure your baby is gaining enough weight.

Sometimes babies fed with a specialty system still have feeding problems or trouble gaining weight. They might be uncomfortable during feeding and not get as much milk as they should. Signs to watch for include:

• coughing (during or after feeds)
• choking
• watery eyes
• furrowing eyebrows
• back arching during feeds

Change your feeding strategy if you see any of these signs from your baby. For instance:

• Try using a slower flow rate nipple to limit the amount of milk your baby takes at one time.
• Allow for more pauses during the feed. Tip the bottle sideways after every few swallows.

If you have any concerns about your baby's feeding, call your cleft and craniofacial team right away. The feeding therapist and/or nurse practitioner can check your baby during feeding. They can make changes to the feeding system or recommend other testing.

How Can Parents Help?

Feeding a baby with cleft lip/palate can be a challenge at first. But help is available. Look to the cleft team for support and information.

Many cleft teams offer prenatal consultations if an ultrasound finds the cleft before the baby is born. Parents meet with the team to ask questions, including any feeding questions. That way, a feeding plan is ready before the baby's birth.

If the cleft is found at birth, the inpatient staff will help parents find a bottle system that works best for the baby. The baby's doctor can refer the parents to a cleft team.

The cleft team usually meets with parents and their babies within the first week or two of life. They'll see how feeding is going and answer any questions you have.

You also can find resources online at:

• American Cleft Palate-Craniofacial Association (ACPA)