This section is intended to give you an overview of some of the issues that may come up when feeding a baby with a cleft, and to share common solutions. Every child is different and will have different requirements, so what works for one parent will not work for all. The information in this section is a general guide only and should never replace the advice given to you by medical professionals.
It is strongly recommended that you contact your Cleft Nurse Specialist in the first instance if you have any questions or concerns about feeding your child. CLAPA staff are not medically trained and cannot give feeding advice.
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In This Section:
- Can I breastfeed my baby?
- What kind of bottles should I use?
- How will I feed my baby after surgery?
- How much weight should my baby be gaining?
- Do babies with a cleft have issues with wind?
- Why is milk coming down my baby’s nose?
To feed effectively, babies need to be able to form a vacuum inside their mouths and to position their tongue properly. A vacuum is formed by sealing the lips around the nipple or teat and closing the back of the mouth using the soft palate (the roof of the mouth towards the back of the throat).
When this is done right, milk is drawn out of the bottle during bottle feeding, and during breast feeding the nipple stays in the right position on the back of the tongue.
Babies use a natural reflex action involving sucking, breathing and swallowing to feed, and forming a vacuum is what allows them to suck. Some babies with a cleft aren’t able to form this vacuum because of the gap in their lip and/or palate, so feeding from a regular bottle or a breast is very difficult. It’s like trying to drink through a straw that’s full of holes. The special bottles provided by CLAPA are designed to help overcome these problems.
Different kinds of cleft
Babies with a cleft palate may need extra help to feed, which could include using specialised bottles and teats, or in some cases using a nasogastric (NG) tube.
For babies with a cleft lip, the size and shape of the cleft may make forming a seal around the breast or bottle difficult.
Babies born with Pierre Robin Sequence have a small lower jaw (mandible), and in the early months their tongue is positioned at the back of the mouth. This can affect breathing and swallowing for the first 3-5 months of life. Read more about feeding babies with Pierre Robin Sequence.
Babies with clefts may swallow more air than normal during feeding due to their difficulty forming a vacuum seal, especially if the flow of milk is either too slow or too fast. They may show this by having a blue ‘moustache’, being extra sleepy or bringing up some of their feed. If this happens, stopping two or three times during the feed to burp the baby may be helpful. You can also talk to your Cleft Nurse Specialist to see if changing bottles or teats might be helpful.
What can help
Make a note of the medical professionals who can help you with feeding, such as your Cleft Nurse Specialist, and contact them if you are concerned.
Every mother and baby is unique, so it is not possible to give hard and fast rules to follow. Some babies feed easily and others take more time to find a way which suits them, even if they have the same type of cleft. Try and give yourself time to sit comfortably and be relaxed. Make sure your baby is given enough time with one method of feeding before trying alternatives.
VIDEO: Easing the First Few Hours – Chapter Seven – Feeding
This short video (2:55) walks through the problems a baby with a cleft may have with feeding, and how this can be managed, including bottle-feeding and breastfeeding.
Some methods commonly used to help babies with a cleft feed more effectively are:
- Identifying the difference between quiet dummy sucking (where the baby just breathes and sucks) and effective sucking (where the baby coordinates sucking, breathing and swallowing). This can be done with the help of a feeding specialist.
- A different approach to breastfeeding, such as a new position. A feeding specialist can advise you on this.
- A differently shaped teat with a larger or differently-positioned hole
- A different bottle for bottle feeding, such as the MAM or Dr Browns bottles provided by CLAPA, and/or a bottle with a scoop or specialist teat attached.
- Very occasionally, a thin feeding tube may be passed into the stomach through the nose or mouth, called a nasogastric or NG tube. It is usually used to help babies who have a small jaw, such as those with Pierre Robin Sequence. This is usually used together with breast or bottle feeding.
- Sometimes, the baby is given a small feeding or orthopaedic plate to wear on the roof of the mouth. This is made by an orthodontist to assist with breast feeding (as it helps the baby to form a vacuum), protect the delicate tissue in the roof of the baby’s mouth, and to keep the baby’s tongue out of their cleft. However, not all Cleft Teams agree on the benefits of using these plates, so their use is quite rare. Sometimes special orthopaedic plates can help to start closing and aligning a cleft palate prior to surgery, and if this is the case the orthodontist will need to see your baby regularly to make adjustments.
Babies do not produce very much saliva during the first two months of life.
With a cleft palate, milk can enter the nose during feeds, and while breast milk does not irritate the delicate tissue here, formula milk can leave deposits which may result in a snuffly baby. Formula-fed babies may require 2/3 teaspoons of cooled boiled water after a feed to ensure that any milk is removed from the nasal airways.
Children with a cleft which affects their gums are especially vulnerable to tooth decay, as the position of their teeth can be crooked or twisted at and therefore harder to clean. As they grow older and get their milk teeth, maintaining good oral hygiene by cutting down on sugar and regularly visiting the dentist is essential. See ‘Early Years‘ for more information and tips.
Typically, there is no difference in the timeline for weaning a baby with a cleft, and unless your Cleft Team suggests otherwise, you can follow the usual NHS guidance.
The texture of the food needs to match your baby’s stage of development. Generally start with purée and then move on to mashed foods. Ask your Cleft Nurse Specialist if you need help. Delay with weaning may cause problems introducing new foods later on. When weaning your baby try and introduce a varied and balanced diet.
As with milk, food may pass into the baby’s nose through a cleft palate and cause sneezing. This may be distressing at first but is nothing to worry about, just have a bib or some tissues ready to catch the mess! Your baby will soon learn to cope. Finish the meal with a drink to help clear the food from the cleft area. It may also help to change the texture of the food.
When introducing a trainer beaker (or ‘sippy cup), some Cleft Teams will recommend you use one with a soft or a short spout that won’t affect the healing of the palate repair. It may be hard for your baby to suck from a ‘non-spill’ beaker, so try to avoid these if possible. A ‘doidy cup’ is often recommended for children who have real trouble sucking through a teat, though as these have an open top they’re better for older children.
A cleft in the lip may extend into the gum and bone of the jaw where teeth develop. This can lead to some front teeth coming into the mouth twisted and in the wrong position. It is important that your baby grows up with strong teeth, as future treatment may be needed to straighten them. You can do this by limiting sugar, avoiding syrupy drinks, and giving sugar free medicines and vitamin supplements at mealtimes. See our ‘Early Years‘ section for more information on keeping your baby’s milk teeth healthy.
Can I breastfeed my baby?
Breastfeeding can be possible for a baby with a cleft lip, but is difficult for babies with a cleft palate. See ‘Breastfeeding’ for more information.
What kind of bottles should I use?
Your Cleft Nurse Specialist will advise you on whether or not you need to use specialist feeding equipment. See ‘Bottles & Teats‘ for more information.
How will I feed my baby after surgery?
Individual circumstances will vary, so it’s best to ask your Cleft Team so that if there are to be any changes you will have time to let your baby get used to them first.
After a lip repair surgery, you can usually start feeding your baby again by breast or bottle straight away. In some cases surgeons will recommend you feed your baby using a cup and spoon method for a while. Some Cleft Teams feel that sucking on a dummy after surgery will damage the repair, so it’s best to ask to be sure.
The timing of palate repair surgery will vary, so depending on your child’s age they may be weaned but still using a bottle for milk or other liquids.
Some surgeons prefer you not to use a bottle immediately after the palate operation, so ask your team for advice, as you may need to get your baby used to a spoon bottle or short spouted trainer cup before the operation. The same may apply to a dummy.
How much weight should my baby be gaining?
All babies can lose up to 10% of their birthweight but usually regain it in two to three weeks. If a baby is having five to six wet nappies a day and regular motions, is healthy and alert, these are indications that they are being fed enough.
If you are concerned, contact your Cleft Team or GP. Sometimes, babies will need to be given high calorie milk to help them take in enough nutrition.
Do babies with a cleft have issues with wind?
All small babies require winding and your baby will usually let you know when they are uncomfortable. If the milk flow is correct, your baby will not have more wind than normal. You may hear a ‘hissing’ sound during breastfeeding, if your baby has a cleft lip, which indicates they are not forming a proper seal around the breast and are swallowing too much air.
If your baby appears to be windy try stopping 2 or 3 times during the feed to burp the baby.
Why is milk coming down my baby’s nose?
If the flow is too fast, milk may pass into the nose through a cleft palate and cause sneezing, or some milk may come down the nose if your baby is being sick. Your baby will normally clear this, but have some tissues or a bib handy!
Have another question not answered in this section? Let us know in the comments, or get in touch directly. We are always working to improve our information and ensure it reflects the needs of our community.