As it’s World Breastfeeding Week, we thought we’d explore how breastfeeding works for a baby with a cleft. And if that’s not possible, what the alternatives are. We asked the experts at the Cleft Lip and Palate Association to share their knowledge with us.
Early on in pregnancy, before many women even know they’re pregnant, different parts of the face start to develop. At around 12 weeks, these different parts join together in the middle, causing the little dip most people have above their top lip.
For one in every 700 babies, they don’t join together properly, and the result is a gap or ‘cleft’. This can be in the top lip (cleft lip), the roof of the mouth (cleft palate), or both. While genetics do play a part, most of the time this can’t be predicted or prevented.
Around 1,200 babies are born with a cleft every year in the UK alone and, just like every baby, every cleft is unique. One of the greatest challenges babies with a cleft face early on is feeding. Because of the gap in their mouths, it’s hard to form the airtight seal that lets most babies suckle. It’s like trying to drink through a straw with a hole in it!
Mothers who spent their pregnancy hoping to breastfeed are often told it’s impossible for a child with a cleft. In reality, there are ways to give almost every child the benefits of breastmilk.
Breastfeeding a child with a cleft lip
If your baby has a cleft lip only, breastfeeding is entirely possible if the shape and size of the cleft will allow it. You’ll have to experiment with positions, but what you’re aiming to do is mould your breast to the gap left by the cleft so a vacuum can be formed. Some air will likely still escape through that gap, so listen out for a ‘hissing’ sound, a clue you may need to re-position your baby. You may also need to hold your breast into their mouth to make sure it stays firmly on the back of their tongue.
If your baby manages to feed this way, it’s likely they’ll swallow a lot of air in the process so you may need to stop a few times to wind them. Feeds might take longer, and finding a way that works for both of you might be frustrating. But, with practise, patience and the right support, you can still enjoy this time with your baby.
Breastfeeding a baby with a cleft palate
Babies with a cleft palate will find things harder, and it’s unlikely they’ll be able to breastfeed exclusively. It can work if the cleft is small or narrow, and the breast is held well into the mouth to help them latch on properly. Breastmilk is especially beneficial for babies with a cleft palate, as milk will likely travel up their cleft into their nasal passages; breastmilk won’t irritate the delicate tissue of the nose and throat as much as formula milk.
If your baby doesn’t have a strong enough suck to stimulate the flow of milk, you may need to help them by massaging your breast (ask a midwife or feeding specialist for help), hand expressing, or using a breast pump. You can also do this after or between feeds to make sure you keep producing enough milk.
Special bottles for babies with a cleft
In most cases, you’ll need to at least supplement breastfeeding with bottle feeds to make sure your baby is getting the nutrition they need. There are a number of special bottles and teats (available through CLAPA) which are designed for babies with a cleft. Some of these involve gently squeezing milk into the baby’s mouth; some have valves to help the baby control the flow of milk. It may take a little while to find a combination that works for you both, but with a little luck these bottles can help make feeds a time for peaceful bonding again.
Expressing for babies with a cleft
If you want to use expressed breast milk, check if your local Cleft Team has a pump they can loan you. Otherwise, there’s a wide variety of models available to suit every set of needs. You’ll need to express milk every 2 to 3 hours, and once during the night, to keep up your flow. If your milk is still flowing when your baby has their repair surgery, you may be able to move onto breastfeeding shortly afterwards.
Ask a Cleft Nurse
Whatever your situation, try to take things a week at a time, review your progress regularly, and remember the most important thing is that your baby is fed, no matter how. Your Cleft Nurse will be on hand to find a solution that works for you, and CLAPA’s own online support groups are a fantastic source of support at all hours.
The Cleft Lip and Palate Association (CLAPA) works to improve the lives of people born with a cleft and their families in the United Kingdom. CLAPA’s vision is of a society where everyone affected by cleft feels supported, connected and empowered to take control wherever they are on their cleft journey.
Do you have experience of bottle-feeding or breastfeeding a baby with a cleft? Share your experiences with other parents. You can get do so in the comments below, via our Twitter, Facebook or by emailing firstname.lastname@example.org