By Dr Ananya Mandal, MD
Cleft lip and cleft palate are one of the commonest birth defects that occur when the baby is developing in the womb. A cleft is a gap in either the palate (roof of the mouth) or lip. It can occur separately or together.
Both cleft lip and palate can be corrected through surgery. However, until the deformity can be corrected by surgery, feeding the baby becomes a challenge since the cleft can prevent babies from forming a seal around the nipple and areola with his or her mouth and effectively sucking and removing milk from the breast.
Breastfeeding a baby with cleft palate and/or lip:-
A different breastfeeding position may be tried. The mother can use her thumb or breast to help fill in the opening left by the cleft in the lip to form a seal around the breast. With practice this may work in minor clefts. This is called oral facilitation.
While breastfeeding or bottle feeding a baby with a cleft lip or palate the baby should be held in a semi-upright seated position. This limits the amount of liquid that enters the nasal passage. The mother or caregiver holds the head and shoulders in one hand and the bottle with the other hand.
For breastfeeding mothers, the breast may be held in the other hand to create a sealing. Sometimes a slight trickle of milk may flow from the nose as there is back flow. If the amount is not large and the baby spits up, he or she can be held forward to drain off the excess milk.
The infant should be held so the head, neck and shoulders are in a straight line or the chin is slightly tilted toward the chest. A bulb suction may be used to remove the milk from the nose.
Babies with a cleft palate carry a risk of the milk coming out of the nasal cavity because of the gap in the palate (roof of the mouth). Hospitals may fit the baby with a mouthpiece called an obturator that fits into the cleft. This prevents back flow of the milk and helps the baby swallow the milk.
If the cleft if very far in the back of the mouth and very small, breastfeeding may not cause any problems.
Feeding expressed milk
If the baby is unable to take breast milk by sucking, the mother can choose to express breast milk and feed it to the baby using special bottles, nipples or even a spoon or cup.
Breast pumping in mothers of babies with cleft lip and/or palate should begin at birth of the baby. High quality electric breast pumps may be used for rapid removal of milk.
Using special nipples can help babies with cleft lip and/or palate. These come in different shapes, sizes, and textures. The holes can also be different that regulate the flow of the milk.
The nipples may be of two shapes - straight “standard” nipples or wide flat “orthodontic” nipples.
Nipples for these babies are usually long for the baby’s tongue to press on it. These special nipples are also soft and milk flows easily so that the baby will not have to suck as much.
Special nipples include Special Needs feeding (Haberman), cleft palate nurser (Mead Johnson) and Pigeon bottle.
Supplemental feedings along with breast milk may be given if the baby does not receive adequate milk for growth and development.
With artificial feeds small amounts and frequent feedings may be required in the initial few weeks. Feedings should be for around 30 minutes with an additional 10 minutes for burping.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)