The NHS recommends exclusive breastfeeding for the first six months of a baby’s life, but feeding issues caused by a cleft lip and/or palate can make breastfeeding very difficult.

At this time, it is important to remember three key things:

  1. It is very unlikely that your child’s cleft was caused by something you did or didn’t do.
  2. Many mothers and babies have difficulties with breastfeeding, regardless of whether or not there are issues like a cleft to deal with.
  3. Any amount of breast milk is beneficial. If you are unable to breastfeed, you may still be able to express milk and bottle-feed your baby.

Babies with a cleft lip

Babies with a cleft lip (without a cleft palate) may be able to breastfeed. There can be difficulties with forming a seal between the breast and lip but, depending on the type and size of the cleft, the breast may be able to mould to the gap.

A hissing sound usually means air is entering the mouth, so try to re-position the baby on the breast to help them to form a vacuum. The nipple needs to stay on the back of the tongue, so it may be useful to help the baby by holding the breast in the mouth. Small changes in the vacuum will result in the nipple slowly moving towards the front of the baby’s mouth which will make feeding less effective.

You may need to try several different positions over time before you find one which works, and it will help to seek support from medical professionals experienced in feeding babies with clefts, such as your Cleft Nurse Specialist.

A good flow of milk helps and this can be encouraged by massaging the breast or using a breast pump. Your midwife or a feeding specialist will be able to help you with this.

Babies with a cleft palate

Breastfeeding a baby with a cleft palate may work when the cleft is very small or narrow. The breast needs to be held well into the area where there is palate so that the baby can get a good grip and work at the breast with the tongue. A baby born with a cleft palate will need help in achieving a good ‘latch on’. A nurse specialist will be able to help you with this.

If your baby is unable to suckle at the breast before they have their palate repaired at 6-12 months, it is possible, with commitment, for them to taste and lick milk expressed onto the nipple and be fed with expressed breast milk by another feeding method. Any amount of breast milk is beneficial.

For babies with a cleft palate, breast milk can be especially helpful as it does not irritate the delicate tissue in the nose and throat as much as formula milk and can help to reduce the risk of ear problems developing later on.

There are a number of alternative methods, including cup and spoon feeding, and a supplemental nursing system. Many Cleft Teams have breast pumps available for hire which will allow you to express feed your baby. Talk to your midwife or Cleft Team about this, or get in touch with a CLAPA Parent Supporter to discuss your experiences.

It is generally advised to take things a week at a time and review the situation regularly.

General breastfeeding tips

Your baby may not have a strong enough suck to stimulate the flow of milk, so you will need to help them. You can encourage the flow of milk by massaging the breast or using a breast pump. Your midwife or a feeding specialist will be able to show you how to massage your breast and hand express the milk when a breast pump is not available.

If your baby isn’t able to take much milk during the feed, you may need to express more milk after feeding to ensure the breasts receive enough stimulation to keep producing milk.

Your baby will satisfy their thirst on the first suckling and their hunger on the hind milk which contains more calories. Even if you are able to breastfeed, your baby may need to be supplemented using expressed breast milk with an alternative feeding method, as breastfeeding alone may not give them enough milk.

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