Babies with cleft palate commonly have feeding difficulties. Because the roof of the mouth is not formed completely, babies with cleft abnormalities often have trouble creating enough suction to pull milk from a standard bottle or the breast.

With proper teaching, support and patience, most babies with cleft palate go on to do very well with feeding. In some cases, extra support from a feeding team may be recommended.

Breastfeeding your baby with a cleft palate

In the presence of a cleft palate, breastfeeding in the traditional manner is often not recommended, but there are alternative methods for providing breast milk to your baby. Pumping breast milk and using specialty bottles are supported as a way of feeding a baby with a cleft palate. The Breastfeeding and Lactation Program at CHOP, or a local lactation consultant, may be of great benefit to you and your baby as you attempt to establish good feeding behaviors.

Bottle-feeding your baby with a cleft palate

Finding the right bottle for your baby can be a challenge whether a cleft of the palate is present or not. A variety of bottles exist for this very reason. Work with your delivering hospital for specialty bottle recommendations at the time of delivery. If a change is needed once we see your baby, we will guide you in that change.

Some examples of specialty bottles include:

• Enfamil® Cleft/Lip Palate Nurser by Mead-Johnson
• Medela SpecialNeeds® Feeder (formerly Haberman SpecialNeeds® Feeder)
• Pigeon Baby Bottle
• NUK® nipple — this nipple can be placed on regular bottles or on bottles with disposable bags. The nipple may need to be modified to support proper feeding in the patient with a cleft palate.
• Fast flow silicone nipples with modification

Tips for feeding a baby with a cleft palate

The following are some suggestions to help feed your baby with cleft palate:

1. Observe your infant for a period of sucking, followed by a swallow and a brief period of breathing. Do not squeeze the bottle during the swallowing or breathing phase.
2. Keep the bottle tilted so the nipple is always full of milk. This may mean using smaller infant feeders in the beginning.
3. Expect the possibility of milk coming out of the nose along, with some sneezing or coughing. This is not choking. Allow your baby to clear this on their own with observation.
4. Babies with cleft palate should be burped more frequently, but not so often as to interrupt good feeding behaviors.

Choice of formula, management of medical issues, and well-baby care remains at the direction of your pediatrician. Our Cleft Lip and Palate Program team is available to support you and your pediatrician when it comes to the specialized techniques needed in feeding a baby with a cleft palate.

The Cleft Palate Foundation offers additional helpful information about feeding a child with a cleft lip and/or palate.

July 2013