Feeding a Baby with a Cleft Lip and/or Cleft Palate

If your baby is born with a cleft lip or palate, you may be told that breastfeeding is not going to be possible. Depending on the position and severity of the cleft you may discover that you can breastfeed. However, it may look different than imagined. An IBCLC (International Board Certified Lactation Consultant) can help you create a breastfeeding plan. It may take time for you and your baby to figure out if breastfeeding will be possible. Feeding your baby your expressed milk is always an option while you are learning to feed at the breast. Or you may continue to feed your baby your expressed milk long-term if feeding at the breast is not possible, or if that is your preference.

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. They occur in the womb when your unborn baby is developing. They are among the most common birth defects and will be surgically repaired when your baby is old enough for the surgery.

A cleft palate occurs when your baby’s palate does not close while still in your womb. The hard palate (bone) is the front part of the roof of your baby’s mouth. The soft palate (soft muscle) is the back part of your baby’s mouth. A cleft can be of the soft palate or both the soft and hard palates. It can occur on one side of your baby’s mouth or both sides. Another type of cleft is called a ‘submucosal cleft’. This is when there is an opening of muscle or bone that is hidden by intact skin. This type of cleft may not be visible and is often not detected until babies are several days old.

Whether or not your baby will be able to feed directly from the breast will depend on the severity and placement of the cleft. The cleft may prevent your baby from forming a complete seal. Or it may prevent your baby from compressing the breast effectively. If the cleft is small your baby may be able to plug the hole with your breast tissue while she is latched. This will allow her to get the suction required to hold your nipple in place while nursing. It also depends where the cleft is in your baby’s mouth. If the cleft is only on one side your baby may be able to compress the breast effectively enough on the other side to mechanically remove milk, even though she cannot make a good seal. Then she may be more likely to be able to at least partially breastfeed.

Positioning suggestions
A cleft in your baby’s mouth can cause milk to flow back into your baby’s nasal cavity and airway no matter how they are fed. If you are breastfeeding it is important to find a breastfeeding position that will help to prevent this from happening. See Positioning and Latching.

Laid-back position: Use the slightly more upright version of the ‘laid-back position’ with your body at a 55 to 65 degree angle. Place your baby on top of your body at an angle. This will allow gravity to help keep your baby deeply onto the breast. This can help him form a proper seal. It can also help prevent milk from entering his nasal cavity and airway.

Sitting upright position: Another position you may find helpful is to have your baby sit upright with his legs straddling your leg. Offer your baby the same breast as the leg he is sitting on.

Breast support: You may need to support your breast while your baby is latched to help her keep the breast deep in her mouth while feeding.

Dancer Hold: If your baby requires extra help, the Dancer hold can allow you to support her jaw and cheeks to help her stay on the breast.

Breastfeeding After Surgical Repair
In Canada, repair surgery for a cleft lip is usually done when a baby is between three and six months old. Cleft palate repair surgery is usually done when a baby is between six months and one year old.