A baby born with a cleft lip should have little, if any, difficulty with feeding.
Your baby should be able to breastfeed normally and any initial difficulties can usually be resolved by re-positioning the baby.
If there are any slight difficulties with a baby that is bottle fed, it may be necessary to adjust the hole in the teat or change the teat completely. Your baby may find it easier to feed using a latex teat as these are softer than silicone and can mould to the shape of the baby’s mouth more easily.
Our clinical nurse specialists (CNS) are able to offer help and advice about different breastfeeding positions, teats, bottles and stockists.
Babies born with a cleft lip and palate have a gap in the muscles and soft tissue of the roof of the mouth and a gap in the lip and gum. This makes it difficult for them to position and use the nipple or teat as other babies do when sucking and feeding.
Although your baby will be able to make sucking movements with their mouth and jaw, they will be unable to create and sustain the pressure required to draw the milk from the breast or bottle. Some babies may need an orthodontic plate to be fitted. Other babies may require tape strapping over the upper lip area. If either of these are necessary your clinical nurse specialist will discuss this with you.
Having a cleft lip and palate makes it difficult for your baby to latch on to the breast properly and stay latched on.
You can still put your baby to the breast but they must be topped up with expressed breast milk or formula after each feed using a cup or bottle. Alternatively you may choose just to express your breast milk and give it via a bottle. Your clinical nurse specialist will be able to discuss this in depth with you.
We would recommend the use of an electric pump (for example, Ameda or Medela) for expressing. The clinical nurse specialists have a small supply of electric pumps which are available for you to borrow for as long as you wish (these are kindly funded by local cleft charities and charitable funds). The benefit of an electric pump is that it is usually quicker and more efficient. It is also possible to pump from both breasts at the same time. A few mothers prefer to use a small hand pump as this enables you to move about while you are expressing the milk but it is usually more time consuming than an electric pump. Again your clinical nurse specialist, in conjunction with your midwife and health visitor, will be able to discuss this with you.
Your clinical nurse specialist will assess your baby soon after birth and discuss with you which bottle and teat would be best to use.
The bottle we usually recommend is a MAM soft bottle; being soft it allows you to gently squeeze the milk into your baby’s mouth in rhythm with their sucking (assisted feeding). The bottle is used with a latex orthodontic shaped teat size 1 or 2 depending on the weight of your baby. We advise the use of a latex teat because it is softer than silicone, making it easier for your baby to suck. It also moulds to the shape of the mouth. Your clinical nurse specialist will advise you and work together with your hospital nurse and health visitor to help through this time.
Your clinical nurse specialist will also provide you with a starter pack of bottles and teats. Further bottles and teats are available from CLAPA.
There is no need to change bottle and teats around the time of surgery.
Common problems and concerns
If your baby is sick after a feed you may notice it coming down their nose. This is perfectly normal for a baby with a cleft palate.
Does it matter if my child sucks a thumb or a ‘dummy’?
Thumb sucking is a normal comfort habit and will cause no long-term problem if it stops before the permanent teeth erupt. A ‘dummy’ has a similar effect on the teeth as the thumb but needs to stop at an earlier stage.
Any problems which may arise are usually fairly short lived, but it can sometimes take a few weeks before your baby’s feeding is well established and they have a good weight gain. Your clinical nurse specialist, working together with your midwife and health visitor, will continue to advise you in hospital and at home.
If you have any problems, concerns or worries regarding feeding, please contact your clinical nurse specialist.