Kids Health Info

Cleft lip and palate infant feeding

  • Babies spend much of their time feeding. To feed well, they need to position their lips and tongue around the nipple or artificial teat, and create both suction and compression during sucking. 

    When a baby is born with a cleft palate or combined cleft lip and palate sucking is more difficult. There are a number of ways to help these babies feed well.

    Cleft lip

    Babies born with a cleft lip alone usually feed well. Some babies breastfeed better with the cleft facing upwards. The breast tissue usually fills the gap where the cleft is and allows efficient feeding. Some bottle fed babies feed better on a wide based teat.

    Cleft palate

    Babies with cleft palate often look like they are feeding well because the lips and tongue close around the nipple or artificial teat like non-cleft babies and the jaw moves well during sucking.

    But most babies with cleft palate cannot generate suction during feeding. The lack of suction makes it difficult, and for some babies impossible, to breast or bottle-feed efficiently. Consequently, feeding can take a long time and be tiring for the baby who may not get enough milk to grow and develop well. Help is available to manage these feeding problems.

    Cleft lip and palate

    Babies with cleft palate can't create enough suction during feeding to draw milk from the breast or bottle easily. This is because air leaks from the mouth through the cleft into the nose during feeding. If the baby also has a cleft lip he/she may not be able to compress the breast or teat well enough to push milk from the breast or bottle.

    In either case, feeding is usually slow and tiring and the baby may not drink enough to grow well. These problems are usually solved by using teats and bottles especially designed for babies with cleft palate. Your cleft coordinator can show you the different bottles and teats available and demonstrate how to use them.

    You can buy this equipment at:

    • CleftPALS (contact details are below)
    • your local pharmacy (although you may need to make a special order if using your pharmacy).

    Breast feeding

    Breast milk is best for babies. When babies can't feed well directly from the breast mothers may choose to feed their baby expressed breast milk from a bottle. Lactation consultants and maternal and child health nurses are able to provide specific advice and support to new mothers who wish to express breast milk for their baby.

    Bottle-feeding

    If your baby feeds well from a standard teat or bottle bought from a supermarket or pharmacy there is no need to use the equipment described below.

    A number of special teats and bottles are available for babies who cannot generate suction and/or compression during feeding. They come in different shapes and sizes and have several features in common.

    • The bottle (or in the case of the Haberman feeder, the teat) can be squeezed while the baby is sucking. This pushes milk into the baby's mouth and compensates for lack of suction.
    • The teat often has a one-way valve which keeps it full of milk. This is helpful for babies who can compress the teat but can't generate suction. It is also thought to minimise wind.
    • The teat often has a 'cross-cut' rather than a hole in the end. This stops milk dripping into the baby's mouth when they have stopped for a rest during feeding.

    Feeding tips

    Each baby is unique so different techniques will suit different babies even if they have the same kind of cleft. However some general tips are:

    • Feed your baby in a calm quiet environment. Make sure you are sitting in a comfortable chair.

    • Seat your baby fairly upright for bottle feeding. This may prevent milk coming
      out of your baby's nose during sucking. Hold your baby close to you so he/she is well supported during feeding.

    • If your baby also has a cleft lip, avoid placing the teat into the cleft.

    • Once your baby starts sucking, squeeze the bottle gently to deliver milk into the mouth. If you are using the SpecialNeeds® Feeder (Haberman), the teat rather than the bottle should be squeezed. A squeeze every 3 - 4 sucks is usually enough.

    • Some mothers find it helpful to practice squeezing a water-filled bottle to get an idea of
      how the flow changes with more rapid squeezing or stronger squeezing of the bottle.

    • Watch how your baby reacts to the pulsing or prolonged squeezing of the bottle. If the baby looks uncomfortable or is not managing the mouthful of milk stop squeezing and let your baby rest and swallow before more milk is given.

    • Have several breaks for burping, as your baby may be more 'windy' than usual.

    • Keep each feed to 20-30 minutes. Longer feeds mean your baby will use too much energy during feeding. This can make weight gain difficult.

    • Newborn babies can lose up to 10% of their birth weight but usually regain it in 2-3 weeks. If your baby is having 5-6 wet nappies per day and regular motions, and is healthy and alert, then it is likely that he/she is feeding well. Slow weight gain or weight loss may mean the feeding method needs to be changed.

    • Some babies have serious feeding problems (dysphagia) which mean they need specialised help to manage feedng. RCH Speech Pathology can help.

    Cleft-feeding

    Feeding your baby after cleft lip or palate repair

    Your plastic surgeon will give specific instructions on how to feed your child in the first few days after surgery to repair the lip or palate. In general, babies are encouraged to return to their usual method of feeding (breast feeding or bottle feeding) after surgery. If the baby has progressed to solids, these can also be reintroduced  quite quickly after palate repair surgery, but the food should be a soft, 'sloppy' consistency for the first three weeks.

    Introducing solids

    Babies with cleft palate or cleft lip and palate usually start taking solids at the same time as other babies (usually around 5 - 6 months). Sometimes food comes out through the baby's nose during feeding.

    This may improve if you sit your baby more upright or make the food a little runnier. If problems persist, you can contact the speech pathologists for advice.

    Where to get teats and bottles

    You can get bottles and teats from the Royal Children's Hospital's  Equipment Distribution Centre or CleftPaLS. Contact details for both are below.

    Some commonly used teats and bottles

    • The special needs feeder (previously haberman feeder). This has a long narrow teat which is squeezed during feeding to release milk into the baby's mouth. The teat has a 'slit' cut and allows slow, medium or fast flow depending on the orientation of the 'slit' cut during feeding. The teat also has a one-way valve to minimise swallowing of air, and maximise response to compression.
    • Queensland CleftPALS Bottle. This is a soft polythene bottle made by Queensland CleftPALS Inc. It works well with a number of different teats and is gently squeezed during feeding to assist the baby in receiving milk.
    • Pigeon Cleft Teat. This is an isoprene rubber teat, that can be used with a squeeze bottle or a normal rigid bottle. It comes with a plastic regulator that can be inserted into the teat to assist with milk.  When feeding the thicker part of the teat must be facing upwards (towards roof of mouth) for efficient feeding.
    • Chu Chu Easy Feed Teat. This is a silicone rubber teat (Nitrosamine free), that can be used with a squeeze bottle or normal bottle. When feeding, ensure the flat part of the teat is facing upwards (towards roof of mouth).
    • Chu Chu Cross-cut Teat. This is an isoprene rubber teat (nitrosamine free) with a cross cut in the top. It can be used with a squeeze bottle or normal bottle.

    For more information


    Produced by the Department of Speech Pathology in consultation with the Department of Plastic and Maxillofacial Surgery at the Royal Children's Hospital.  First upload: May 2005. Updated October 2010

Disclaimer
This is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. The Royal Children's Hospital accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.