Cleft lip and palate are congenital birth defects caused by an incomplete fusion of the structures in the mouth.

The cleft may involve only the lip, or the lip and the palate, and may involve one side or both sides.

The prevalence of cleft lip and/or palate ranges from 0.8 to 2.7 percent per 1000 live births.

If you’re having or have had a baby with a cleft, you may wonder how this can impact breastfeeding. The presence of a cleft can certainly present many breastfeeding challenges, but it does not mean breastfeeding is impossible.

Skilled and early support from a lactation consultant is important to help establish and then maintain your breastmilk supply and maximise your baby’s ability to breastfeed. Regular monitoring of your baby’s growth (e.g. from your child health nurse) is also important, especially while a feeding method is being established.

In this article:

Breastfeeding refers to a baby feeding directly from the breast.

Breastmilk feeding refers to a baby drinking breastmilk from a bottle, cup, spoon or other methods but not from the breast directly.

Breastfeeding A Baby With A Cleft Lip And/Or Palate

Here are 6 things to know about breastfeeding your baby with a cleft.

#1: Breastmilk/Breastfeeding Is Important

Breastfeeding or breastmilk feeding is important for babies with clefts. For example:

Ear infections are more common in babies with clefts. Breastmilk helps protect against ear infections in babies with a cleft palate.
Breastfeeding may facilitate the development of muscles of the mouth and face. This may be important for later speech development.

#2: Breastfeeding Can Be Possible

In order for your baby to be able to remove milk from your breasts, she needs to be able to generate suction. Babies with clefts often have trouble creating suction, especially when the cleft involves the palate, because the passage between the nose and mouth cannot be closed off. Babies with clefts may tire more easily from working so hard to maintain suction.

Babies, whose cleft solely involves the lip, are more likely to be able to breastfeed than babies with a cleft palate.

At some point, your baby’s cleft will be surgically repaired. Once this occurs, breastfeeding may become more of a reality. Repair of a cleft lip often occurs within a few months after birth, and repair of a cleft palate often occurs between 6-12 months. Depending on your doctor’s advice, breastfeeding can typically commence or recommence straight or soon after a cleft repair.

Even if your baby has not breastfed before her repair, it’s still possible for her to learn to breastfeed after the repair. A lactation consultant will be able to help.

#3: There Are Many Tips To Help Your Baby Breastfeed

There are many tips to help optimise how well your baby breastfeeds.

If your baby has a cleft lip:

Hold her so that her cleft lip is orientated toward the top of the breast. For example, if she has a right cleft lip, she may feed better when held in a cross-cradle hold when feeding from your right breast and in a football hold when feeding from your left breast. If she has a cleft lip on both sides, a straddle position may work best.
You can seal off her cleft lip with your thumb or finger while she feeds and support her cheeks to reduce the width of her cleft and increase closure around your breast.

If your baby has a cleft palate or cleft palate and lip:

Hold her in a semi-upright position to minimise how much breastmilk gets into her nasal passages. Breastmilk will not hurt her nasal passages though.
Position your breast toward the side of her cleft that is the most intact. This may help prevent your nipple from being pushed into the cleft site. If her cleft is very big, tip your breast downward to stop your nipple being pushed into her cleft.
Support her chin to stabilise her jaw during sucking and support your breast so that it remains in her mouth.
You may need to hand express your breastmilk into her mouth to compensate for the absence or lack of suction your baby can make.

Other tips:

Breast compressions can help maximise how much breastmilk your baby gets while breastfeeding. To do breast compressions, encircle your breast by placing your thumb on one side of your breast and your fingers on the opposite side. Squeeze your breast when your baby is sucking but not swallowing. Then, stop squeezing when your baby stops sucking or stops swallowing. Repeat each time your baby sucks but isn’t swallowing.
Changing sides often (e.g. two or more times during a feeding session) can help maximise how much milk your baby gets too, as each time she switches breasts, she gets a stronger flow of milk.
Babies with clefts often tire easily during feeds. Hence, short frequent breastfeeds often work better than longer less frequent feeds.
Get your letdown reflex going before putting your baby to your breast. This can mean she gets an immediate reward and it helps mimimises the energy she uses.
Skin-to-skin contact between you and your baby as often as possible can help provide your baby with positive and familiar experiences of being close to your breasts.
When your baby shows feeding cues, hold her close with lots of skin-to-skin contact and offer a breastfeed. Babies typically attach and feed better when their feeding cues are responded to in this way.

You may like to speak with your doctor about the use of a fitted dental plate (palatal obturator). This is custom made to create to fit your baby’s palate. There is limited evidence this helps with breastfeeding or weight gain for babies with clefts. However, it may work for some babies.

Even if your baby receives most of her breastmilk from a cup or bottle, any amount of time she spends at the breast helps exercises her mouth and facial muscles and helps prepare her for breastfeeding once her cleft is repaired.

#4: Expressing Can Help Provide Your Baby With The Breastmilk She Needs

It’s common for babies with cleft palates not to be able to get all the breastmilk she needs from breastfeeding. It’s important to be aware of the reliable signs of adequate milk intake.

However, even if your baby cannot get all she needs from breastfeeding, you can still provide her with what she needs by expressing and providing her with your expressed breastmilk.

Before your milk comes in, hand expressing is ideal. Then once your milk comes in, double pumping with a hospital grade electric pump and finishing up with a few minutes of hand expressing can maximise the amount of milk you remove.

Read here for information about expressing in such situations and here for information about storage of expressed breastmilk.

#5: There Are Many Feeding Equipment Options

There are many options for feeding equipment. It’s important to work with a lactation consultant to find out what might work best for you and your baby.

For some, a breastfeeding supplementer may be helpful. This is where a baby receives some additional milk while at sucking at the breast.

Nipple shields may be helpful in some situations such as if your baby is not attaching or has gotten used to a bottle teat. Find out more information about nipple shields.

There are a variety of special cups and bottles that have been specifically designed for babies with cleft palates in mind. Speak with a lactation consultant to help you work out what might work best for you and your baby.

#6: There’s Further Support And Information Available

For more information about breastfeeding and clefts, see the Australian Breastfeeding Association booklet Breastfeeding: babies with a cleft of lip and/or palate. To purchase this booklet call 03 9885 0855 or email info@breastfeeding.asn.au.

Breastfeeding can be challenging, even without the extra challenge of having a baby with a cleft. Having support around you is important. A lactation consultant, Australian Breastfeeding Association counsellor or La Leche League Leader can all offer information and support.

There are also various Facebook support groups you may find helpful such as:

There is also a national Australian organisation called CleftPALS (Cleft Palate and Lip Society) which consists of parents and professionals involved in the management of babies with clefts. CleftPALS provides information and support for parents with babies with clefts. There are CleftPALS branches all around Australia.