Cleft Lip & Palate Guide

Feeding Your Child

Like all babies, most infants with cleft lip and palate are born ready to eat by mouth, but they may need special care during feedings. Due to the size and place of your baby’s cleft lip and/or cleft palate, he may not have enough suction and strength to draw milk from the breast or bottle. For that reason, there are special nipples that can be used to help with your baby’s feeding. Breastfeeding babies may refuse to nurse when they find they are unable to get much milk. Or, they may be unable to stay latched at the breast.

Babies with cleft lip and palate tend to tire quickly, because they use more energy trying to eat. Our staff can assess your child’s feeding skills and decide on the most useful feeding method for your child’s needs. Feeding can be frustrating the first few weeks, but this will pass with training and support.

  • Feedings should last no more than 30 minutes, whether breast or bottle feeding.
  • Feedings should be pleasant for both you and your baby. This can help your child gain weight.
  • You may need to use special feeding bottles, even if you are giving breast milk to your baby.

  • Breastfeeding

      The goal of breastfeeding is for your baby to gain weight and enjoy feeding. A few babies with a cleft lip and palate can get all of their food by nursing. Most can nurse a bit, but also need supplemental (extra) feeding.

      - Babies with just a cleft of the lip are better at nursing.

      - Your baby’s success depends on the type of cleft and your milk supply.

      - It is often not clear if a baby with a cleft palate can nurse well at the breast until your milk has "come in." We advise putting your baby to breast several times and follow-up with supplements of pumped milk (or formula if needed). This helps to ensure that your baby gets enough food in the beginning.

      Even if your baby is not nursing at the breast, breast milk is still the best feeding choice for babies with clefts. Breast milk:

      - Helps your baby prepare for and recover from cleft lip and palate surgery and provides protection against infection

      - Is easily digested and contains growth hormone

      - Breastfeeding or just spending "skin-to-skin" time with your baby helps with other things as well—mother and baby both benefit from the comfort and time getting to know each other

      If you pump for several feedings or more a day, it is best to use a double electric breast pump. Contact a local pump rental company or lactation consultant for more information.

      - Your lactation consultant can help you set a pumping schedule that matches your baby's needs. She can also teach you about milk storage and give you other support when you need it.

      - Accept help from family and friends to free your time to pump and rest.

      - Spend more "skin-to-skin" time with your baby to improve your let-down before pumping.

      Pumping is not as pleasant as breastfeeding; accept this and continue so long as you feel it is of value to you and your family. Your baby will benefit from mother's milk so long as you are able to provide it. Some families prefer to freeze some milk to use before cleft lip and palate surgery since hospitals often allow breast milk as a "clear liquid." Clear liquids can be given closer to the time of cleft lip and palate surgery than formula.

      *Skin-to-skin time tip: practice feeding at the breast without expecting feeding.

  • Choosing a Nipple

      Once your child’s feeding skills are assessed, the feeding team can talk with you about a nipple and bottle for your baby. The feeding team is made up of a nutritionist, lactation consultant, occupational therapist and speech pathologist. Depending on the size and type of the cleft lip and palate, your baby may need a special bottle or nipple. There is no "perfect" nipple. The best nipple is the one that works best for your child.

      Some of the nipples commonly used by the feeding team at Children’s include:

      - The Mead Johnson Cleft Palate Nurser has a cross-cut nipple so parents can control the flow of food by squeezing the bottle.

      - The Pigeon nipple has a hard side that is placed at the roof of the mouth and a soft side placed on top of the tongue. No suction is needed to express formula, just compression of the tongue.

      - The Haberman Feeder has a silicone nipple with varied flow rate. The baby may be able to feed by himself once he learns how to use it. This nipple does allow for squeezing by parents to help your baby's sucking if needed.

      The feeding team may suggest other nipples and bottles. In most cases, a bottle will work for your baby. In a few cases, a baby may be unable to take full feedings by mouth or be unsafe to feed by mouth. A feeding tube may be needed. The feeding team will then work with you to move toward all feedings by mouth when your child is ready.

  • Feeding After Surgery

      After cleft lip and palate surgery, your child’s feeding schedule may need to be changed for a day or two. Your child can usually resume feeding with the same nipple and bottle after surgery.

      In some cases, you may also need to use a syringe or other method for a while. Your doctor and Craniofacial team can explain any feeding changes to you and teach you what you need to know to feed your baby.

  • Tips for Feeding Your Child

      Keep your child in a good position for feeding

      - Keep your baby upright at an angle between 45 and 90 degrees. This will help prevent milk from running out his nose.

      - Try to keep his chin tucked toward the chest. This improves the suck and reduces the amount of swallowed air.

      Point the nipple away from the cleft lip and palate

      - If possible, angle the nipple away from the side of the mouth with the cleft lip and palate. This will help your child gag less.

      - Do not place the nipple inside the cleft. Let the tongue reach for it and begin the sucking motion.

      Be ready for nasal regurgitation

      - Nasal regurgitation is when food comes back out of your baby’s nose during a feeding. When this happens, do not panic. Pause to let your child sneeze or cough, wipe his nose and resume feeding.

      - If this happens often, try holding your baby more upright during feedings.

      - Keep your baby’s mouth and nose area clean. Use a bulb syringe as needed. If the area around the nose or lip is crusty, clean it gently with sterile water and a cotton swab.

      - Let the feeding therapist know if this continues. She may be able to find a better bottle match.

      Ask about special bottles and nipples

      - A bottle or nipple made for children with a cleft lip and palate can make feedings easier for you and your child.

      - Ask the nurse, occupational therapist, nutritionist, lactation consultant or speech pathologist on your child’s Craniofacial team about such products.

      Stick to a feeding schedule

      - Place your baby on a feeding schedule. Within the first two weeks of life, a newborn may need to feed every two to three hours. Missed feedings might mean your baby is not taking enough volume at feedings.

      - Limit feeding sessions to 20 to 30 minutes. Infants with a cleft lip and palate often work hard during feedings and tire easily. If allowed to feed longer, they may burn more calories than they take in from the bottle or breast.

      - Ask your child’s Craniofacial team for help in preparing a feeding schedule for your child.

      Burp your baby often

      - Burp your baby about every 15 minutes during and after feedings.

      - Infants with a cleft lip and palate take in a lot of air when they swallow. This can cause painful gas buildup if they do not burp often.

      Keep your baby upright after feedings

      - Wait 30 minutes after feeding before you let your baby lie down. This can reduce the chances of food being spit up.

      - Use an infant seat, baby sling, bouncy seat or car seat to help keep your baby upright.

      Follow these tips, and watch your baby closely for any problems:

      - To make sure your baby is gaining weight as fast as he should, record his weight every week for four to six weeks. He should gain about 1 ounce each day after 2 weeks of age.

      - Have regular checkups with your child's primary care doctor; share your child's records with his Craniofacial team.

      Ask your child's Craniofacial team for help with any feeding problems. We have a special Craniofacial and Lactation Infant Feeding Clinic to help with your child's feeding problems.

  • Tips for Feeding Your Child Solid Food

      Solid foods should be given by spoon—not in a bottle. Here are some guidelines to help you with feeding:

      - Keep your child upright in an infant seat or high chair.

      - Offer one spoonful at a time. Offer small amounts at your child's own pace. Do not rush. Your child will let you know when he is ready for his next bite.

      - Let your child use his lips to clear food from the spoon.

      - Do not panic if food escapes through your baby's nose. This will continue to happen until the palate is closed. Pause to let your child sneeze or cough, wipe his nose and resume feeding. If this happens often, try a more upright feeding position. Use a bulb syringe if needed to help clean the area.

      - Avoid acidic and spicy foods. They can irritate the inside of your child's mouth and nose.

      - Start with purees and infant foods when advised by your child's doctor. You can start purees before the palate is closed.