Feeding an Infant with a Cleft Palate

Feeding a child with a cleft lip and/or palate often requires special care. Based on the size and location of your child’s cleft, he or she may not be able to create enough suction to take milk from the breast or from a standard bottle.

There are special nipples that can be used and resources available to assist you in feeding your newborn. It may take trying a few methods and a little practice before you find the method that works best for you and your baby. Feeding may seem frustrating during the first few weeks, but it will get easier.

A valuable resource to familiarize yourself with feeding and tips and techniques is located on the Cleftline website of the American Cleft Palate Foundation.

Bottles

There are several bottles that are specifically designed for feeding babies with clefts. Some children may be able to use a standard bottle with the nipple modified to have an enlarged “X” cut into it, thereby decreasing the work required to express milk. Most children, however, require the use of a special bottle/nipple. Several bottle options are described below. The best bottle is the one that works best for your child.

The Dr. Brown Specialty Feeding System uses a unique bottle/nipple/valve system that allows an infant to assist the expression of milk by pressing his/her tongue against the nipple. It does not require the parent to compress the nipple or bottle to assist in the delivery of milk.
The Mead/Johnson Nurser has a bottle made of a soft, squeezable plastic and has a longer nipple than most standard nipples with a cross-cut tip. The Mead/Johnson Nurser is an “assisted delivery” bottle in that you can assist your child by squeezing the bottle to increase the flow of milk into your child’s mouth. These bottles cannot be warmed in the microwave, boiled, or placed in the dishwasher.
The Haberman Feeder is also an “assisted delivery” bottle. It consists of an elongated nipple. The flow rate can be varied by changing the direction of the nipple (lines on the nipple correspond to the flow rate). The delivery of milk into your child’s mouth can also be increased if needed by squeezing the nipple.
The Pigeon Nipple has a soft and hard surface. The hard surface is placed along the roof of the mouth away from the cleft, and the soft side is placed on the tongue. The baby can express milk by pressing his or her tongue against the nipple and does not require the child to create suction.

Breast Feeding

A few babies with clefts can get all their food by nursing. Most babies with clefts that breastfeed will require supplemental bottle feeding. Success at breast feeding depends on the type of the cleft and the mother’s milk supply. Some babies are just not able to be exclusively breastfeed. Do not consider this as a failure—there are other ways to bond with your newborn and pumping is also an option.

Trouble Shooting

Finding the best method for you and your child may take some trial-and-error. Here are some tips:

Position: Keep your baby upright at an angle between 45 and 90 degrees during feedings. This will help prevent milk running out the nose. Pointing the nipple away from the cleft may also help your child gag less. Nasal regurgitation (milk coming out of the nose) is a common concern for parents. If this happens, pause to let your child sneeze or cough. Wipe his/her nose and resume feeding, holding your child in a more upright position. It may also be helpful to wait 30 minutes after feeding before you let your baby lie down if you are experiencing problems with your child “spitting up.” Some parents find that putting their child in a sling, bouncy seat, or car seat after feeding is helpful.
Burp your baby often: Infants with clefts tend to take in more air when they swallow compared to infants without clefts. This gas build-up can be uncomfortable for your child and cause him/her to stop feeding. It is helpful to burp your baby about every 15 minutes during feedings.
Time: During the first two weeks of life, a newborn may need to feed every 2-3 hours. A good goal is to keep feeding sessions to about 30 minutes. If allowed to feed longer, your child may get tired and end up burning more calories than are consumed. If feedings last longer, it may be helpful to adjust your technique. For example, one can try increasing the flow rate or assist the child more often (depending on the bottle being used).
Amount: Newborns generally take in approximately 2-3 ounces per feeding. (Breastfed infants usually take smaller, more frequent feedings). However, some babies may have higher or lower requirements (check with your child’s primary care provider). There are several clues that your child is getting enough nourishment: your baby has frequent wet and dirty diapers, appears satisfied after feeding, and is gaining weight. Your pediatrician will monitor your baby’s weight. This is one of the best ways to tell how well-nourished your child is. During the first week, most infants lose several ounces of weight, but they should be back up to their birth weight by the end of the second week. Your baby should gain approximately ½ to 1 ounce per day during the first 3 months. Have regular check-ups with your child’s primary care doctor.

Some Final Thoughts

You and your child will develop a feeding schedule with time. Finding the best method for you may take some trial-and-error. Try to not get discouraged. The first few weeks are the toughest. Remember to sleep when you can and don’t be afraid to ask family members and friends to help. Having a child with a cleft does not mean that you are the only one that can feed your baby. Teaching family members and friends how to feed your baby can give you a much-needed break and may also help to lessen tensions and fears.