Breastfeeding a Baby with a Cleft Lip and/or Cleft Palate

My goal for this article is to provide a basic summary about breastfeeding with cleft lips and cleft palates and to share some links for further information and help.

Cleft lips/palates are birth defects that occur during pregnancy where the sides of the upper lip/roof of the mouth do not grow together properly.  They tend to run in families, but there is also evidence that certain environmental factors may contribute.  Thankfully, cleft lips and palates are correctable by surgery.  Babies with cleft lips can usually breastfeed immediately after corrective surgery, and babies with cleft palates can usually nurse 1 day after surgery. (1)

What about in the mean time before a baby has surgery; will he or she be able to breastfeed? The size and type of cleft influences how much suction can be created while breastfeeding.  A baby with just a cleft lip will be most likely able to breastfeed successfully, because he or she can still create the suction and negative pressure necessary to nurse effectively.  (1) Actually, many babies find breastfeeding with a cleft lip easier than drinking from a bottle.  (2) However, cleft palates do make breastfeeding very challenging.  Babies with this sort of issue may not be able to breastfeed successfully.  Working with a lactation consultant experienced is this area is invaluable for both types of clefts but especially cleft palates.  Nevertheless, attempting to breast a baby with a cleft lip or palate is important, because breastmilk contains a lot of anti-inflammatory properties that help prevent respiratory and ear infections.  Babies with clefts who formula feed tend to have more of these kinds of infections.  (1) If a baby is unable to nurse at the breast, giving breastmilk in a syringe, spoon, cup or bottle is the next best choice. (2)

For those babies with a cleft lip, particular nursing positions may help things go more smoothly.  One possibility is to hold baby so the "cleft lip is oriented towards the top of the breast." Also, using the cross cradle hold when nursing on the right breast and the football hold when nursing on the left breast may help with breastfeeding success.  If a baby has a bilateral cleft lip (on both sides), "the face on straddle position may be more effective than all other breastfeeding positions." (2) 

If a baby has a cleft palate only or a cleft palate and a cleft lip, a semi-upright position is best to avoid regurgitation of breastmilk and to avoid breastmilk going into the eustachian tubes in the ears.  Also, "a football style/twin position may be more effective than a cross cradle position."  Other helpful strategies include positioning the breast towards the part of the palate with the most intact bone, positioning the breast downward so the nipple is not pushed into the cleft, and supporting babies chin and/or the breast while nursing. Another unusual idea is to manually express right into the baby's mouth! (2)




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