Bottle Feeding & Expressing

This page is for parents who are bottle feeding their babies with expressed or formula milk. Bottle feeding can be used by itself or to supplement breastfeeding.

This page is for parents who are bottle feeding their babies with expressed or formula milk. Bottle feeding can be used by itself or to supplement breastfeeding.

In this section

Feeding Assessments

How does bottle feeding a baby with a cleft work?

Tips on Expressing Milk & Kit List

Formula Feeding & Kit List

Feeding Assessments

Babies with a cleft can usually be fed using specialist teats and bottles such as the ones provided by CLAPA. It is generally advised that you do not stock up on bottles and teats before your baby is born, as it is very difficult to tell before birth how a cleft will affect their feeding and you may end up being unable to use the equipment you’ve bought.

After a baby with a cleft is born, a Cleft Nurse Specialist aims to visit the mother within 24 hours and assess the baby’s feeding needs. If special bottles and teats are needed, the mother will be given a recommendation as to which ones to use, as there are a number of options.

CLAPA sends out a free Welcome Pack of bottles and teats to new parents in the UK who need them. This contains either a packet of two teats and two MAM squeezy bottles, or a set of Doctor Browns’ bottles and teats, and a set of literature and information from CLAPA.

CLAPA staff are not medically trained and cannot give advice on feeding or recommend bottles and teats for parents to use. Please call your Cleft Nurse Specialist if you have any questions or concerns.


How does bottle feeding a baby with a cleft work?

As with breastfeeding, a baby needs to form a seal with their lips and the teat to be able to feed effectively.

Many babies will need extra help so they can get enough nourishment in a reasonable time, say 30-40 minutes. To do this, you need a teat on which your baby can grip well, and a good flow of milk.

Some babies can feed well with an ordinary bottle and a soft teat, though the hole may need to be enlarged (or another hole made). This can be done by using a needle or paperclip which has been sterilised by being held in a flame until it is red hot. It must be in the flame for at least a minute so the natural carbon formed on the metal during heating is burned off.

Babies with a cleft may need special feeding equipment such as a soft bottle which can be squeezed, and/or orthodontic teats such as the MAM products sold by CLAPA.

If your baby is feeding slowly, you may want to talk to your Cleft Nurse Specialist about experimenting with different teats, as some babies manage better with one sort rather than another. With orthodontic shaped teats, it’s best to place the hole on the non-cleft side and slightly towards the tongue so that the milk is aimed downwards and away from the cleft.

Some babies need a soft bottle such as the MAM bottles which can be gently squeezed as the baby sucks to help the flow of milk. This may give you more control than an enlarged hole, and is more helpful in teaching your baby to associate sucking with receiving food. Nursing your baby in the normal cradling position is possible in most cases.

It is important to only use soft squeezy bottles when the baby is sucking. Squeezing the bottle when your baby is resting may cause the baby to choke or cough. Your Cleft Nurse Specialist will help you understand how to feed your baby safely using these methods.

Babies born with a cleft palate alone may be nursed and fed on their sides.

Some babies may not have the energy to suck from a teat, and here a cup and scoop method may be helpful. Feeding from a scoop attached to a soft bottle (e.g. a Softplas bottle and scoop) requires less effort from the baby. Your Cleft Nurse Specialist can help you learn how to do this.

Tips on Expressing Milk

Expressing milk involves using a breast pump to stimulate milk production and then feeding the baby using a bottle. It can be used instead of, or to supplement, breastfeeding.

Talk to your Cleft Nurse Specialist or midwife about expressing milk, and see if your Cleft Team can loan you a breast pump.

Recommended Kit List

Two mums put together the below kit list for expressing milk. They both had an antenatal diagnosis of cleft, and so had this all ready for when their babies arrived. These are suggestions only and you may find that something else works better for you. If so, let us know in the comments.

  • An electric breast pump to express your milk. We found the Medela ‘Symphony’ an excellent choice. Your Cleft Team may be able to loan you one.
  • A spare set of bottles for storing the expressed breast milk in your fridge or freezer. The Medela bottles can be ordered online or bought at Boots, they are a good choice as they are BPA free and show exactly how much milk is in the bottle.
  • Breast milk bags that can be used for storing your breast milk in the fridge or freezer. The Medela ‘Pump & Save’ bags are useful as they are pre-sterilized, double layered for long-term storage and compact so that they will not take up too much space in the fridge or freezer.
  • Milton steriliser tablets for sterilising the removable accessories from the breast pump. You can buy these in any chemist or in the baby section of a supermarket.
  • Large plastic container that can be filled with enough water to sterilise the removable accessories from the breast pump (using tap water and the Milton steriliser tablets). We both used a large Tupperware box from a supermarket.
  • Hands-free expressing bra which is rather handy for any woman who likes to multitask. Amazon do a great range.
  • Syringes for manual expressing of colostrum before your milk comes in. Ask at your local chemist.
  • Loaded Kindle/DVD box sets to entertain us while expressing.

Parents’ Experiences of Expressing

Achieving a Dream – Alison’s Story

Alison’s son David was born with a cleft palate and Pierre Robin Sequence. He couldn’t be breastfed at all, but by expressing Alison was able to feed him exclusively on her milk until he was 8 months old.

“Basically, I felt helpless with so much of what was going on with David medically, but expressing was something I could do – a difference I could make.”

Jo’s Story

After reading Alison’s story (above) in CLAPA News, Jo was inspired to write her own piece about feeding her baby who was born with a cleft of the hard and soft palate. While she was able to express her millk at first, Jo eventually had to move on to formula milk, and descibes the way this made her feel.

“It probably took me another four weeks to come to terms with stopping expressing, as I had so wanted to carry on until after Isabella’s operation. I felt at the time that I had let her down but I realise now that I gave my all, and couldn’t in fact have done any more, especially with the demands of a young family.”

Julie’s Story

After her first child was born with a cleft palate and had to be express-fed, Julie hoped that her other children wouldn’t be affected, but when baby number three had difficulties feeding, she she knew right away what to do.

“The first few months of Matthew’s life were very challenging, but I am glad that I stuck with expressing and it is amazing how quickly you adapt to an odd situation. […] I discovered that very few people continue with expressing, but with organisation, determination and know-how it can be done and really is worthwhile.”

Formula Feeding

You may choose to give your baby formula milk, or a mixture of expressed breast milk and formula milk.

Recommended Kit List

Two mums put together the below suggested kit list for formula feeding. They both had an antenatal diagnosis of cleft, and so had this all ready for when their babies arrived. These are suggestions only and you may find that something else works better for you. If so, let us know in the comments.

  • Your chosen formula milk. We both found the organic Hipp brand agreed best with our babies and their sensitive digestive systems. It is useful to get the formula cartons as well as the formula powder. The cartons are more expensive, but very helpful in the early days when you forget to pre-boil the kettle to get cooled, boiled water. The cartons are also useful for when you are out and about as they are easier to use. The formula powder is the most economical way to give your baby formula milk and great for every day use (once you are used to storing pre-boiled water). You can get Hipp formula at Boots and most large supermarkets.
  • Plastic water holders (ideally BPA free) so that you can store any pre-boiled water. Amazon do a great range.
  • Electric sterilising machine for the bottles and teats. We both use the Philips Avent Electric Steam Steriliser which makes sterilising very easy. It is large enough to be able to accommodate the MAM brand of bottles. The cycle is quick which is handy when you have forgotten to steam a set of bottles and need one quickly.
  • Bottles and teats. We were advised to get MAM squeezy bottles and MAM orthodontic teats which we both purchased from CLAPA. We would stress that you should get advice from your cleft nurse about the best feeding solution for your baby.
  • Formula milk powder dispenser for when you are out and about. They are useful as you can put a pre-determined number of scoops of powder in them. This makes preparing a bottle very speedy when you have a hungry baby. Also, ideal for hygienic transport of baby milk powder formula when away from home. We liked the ‘bibi’ brand which you can get on Amazon.



Published: November 2015

Next Review: February 2017

Source(s): Range of feeding literature from Cleft Units, with assistance from Cleft Nurse Specialists in Manchester, Nottingham and South London. Stories and suggestions from parents of children born with a cleft were also used.

If you have a comment or question about the information in this page, or would like to know more about the sources of this information, please contact Communications & Information Manager Anna Martindale at [email protected] or 020 7833 4883.


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