Breastfeeding a baby with a cleft lip and/or a cleft palate is challenging, but it is highly recommended as it lessens the chances for middle ear infections and the need for ear tubes. Keep in mind that the protection from breast milk lasts well-beyond the period in which the baby is breastfeeding. Here are some techniques and tips to help you breastfeed in this situation, but it is also critical that you seek the help of a lactation consultant immediately. You may also want to look into visiting a center with an interdisciplanary cleft/craniofacial team. This way, your baby will see a physician from every specialty typically required by children with a cleft lip and/or palate. In some areas, the hospital staff will contact a local cleft team when your baby arrives. A team coordinator will either visit you in the hospital and examine your newborn, or an appointment with the team will be arranged soon after your discharge from the hospital. You can also contact the Cleft Palate Foundation to help you find a team in your area.
What are the first steps?
Typically, the first thing to be repaired is the lip. Early surgery is recommended and has no greater risks than later surgery. This will give the baby the appearance that mom and dad expected. Between six months and three years of age, surgery on the palate should take place as this will go hand-in-hand with normal developmental changes in the palate.
What if my baby only has a cleft lip and no problems with his palate? Can I still breastfeed?
If your baby has a unilateral cleft lip (one side), he should be able to breastfeed before surgery. The issue is not whether you can breastfeed, but moreso that the baby has to find a way to create a sufficient seal to feed effectively. Many moms have to experiment with positioning, but once they find a good place, they stick with it. Then, press the cleft tightly to the breast, and place your finger over the cleft, which creates a solid seal. In an article entitled "Breastfeeding the infant with a cleft defect," Sarah Coulter Danner, CNM, PNP, states,"The infant with a unilateral defect does better with the breast entering the mouth from the side on which the defect is located; thus, an infant with a right-sided defect of the lip or the palate should be held so that his right cheek touches the breast. If this position works best, the mother can go from the cradle-hold on one side to the football or "clutch" hold on the other. In this way, the infant should have an easier time positioning the mother's nipple and areola onto the larger area of the palate."
Babies with bilateral cleft (both sides) feed better when they are straddled on mom's lap or positioned in a modified football hold, where he is sitting more upright than lying back.
What happens after the lip has been repaired?
The baby can breastfeed! In fact, putting the baby to the breast as soon as possible after surgery can greatly enhance the experience for her. The baby will be able to move the nipple and areola around and against her palate, and she will find a comfort level that works best for her. To entice the baby, you should express some colostrum or milk to help her to latch on. Essentially, the nipple has to remain in the baby's mouth for the duration of the feed and feedings will take longer than usual -- sometimes up to 45 minutes of actual nutritive sucking (not factoring in the pauses) How quickly the baby takes to the breast also depends on the severity of the situation. When there is palate involvement, feeding is much more difficult because there is open space into the nasal cavity and the baby has to gulp fast between breaths so the milk isn't regurgitated through his nostrils.
What if my baby has a cleft lip AND palate? Is breastfeeding a lost cause?
Not at all! Here's how to get it going:
- Stimulate your milk supply by hand expression or by pump.
- Hold your baby in a sitting-up position facing you, with the baby straddling your leg and the head tilted very slightly backward.
- Gently push the breast into the baby's mouth as far as you can. The breast will help seal the cleft.
- Massage the breast before feeding to assist the let-down.
- Stimulate suckling motions by placing fingers under the baby's jaw and firmly pushing up and down. Babies are smart and they "get it" quickly. It won't take long at all for him to begin those suckling movements on his own and eventually they become much stronger.
My doctor mentioned something about a palatal obturator. What is this and how will it help with breastfeeding?
A palatal obturator is a plastic dental appliance which covers the cleft palate and may help the baby to feed. A dentist will take impressions of the baby's mouth to obtain the perfect fit.
Danner SC: Breastfeeding the infant with a cleft defect. Clin Iss Perin Wom Health Nurs 3:634-9, 1992.
Riordan J and Auerbach KG. Breastfeeding and Human Lactation. Jones and Bartlett Publishers, MA.