How to Feed Your Baby with a Cleft Lip and/or Cleft Palate

Babies born with a cleft lip and/or palate may have a harder time feeding than normal. The team in the Children’s Hospital Colorado Cleft Lip and Palate Clinic is here to teach parents how to feed their baby with a cleft, discuss any concerns and answer any questions.

What to know about breastfeeding and bottles for cleft lip/palate:

• A baby with a cleft lip alone may be able to feed normally or with a little help depending on the size of the cleft.
• Babies with a cleft palate usually need to use a special feeding system so that the feeding is safe and successful.
• Babies with a cleft may have a weak suck or may have a hard time creating enough suction to breastfeed or get milk/formula from a regular bottle.
• Babies with a cleft palate may also have liquid or food go into and come out of their nose during and after feeding. This is due to the area of the palate that is open between the nose and the mouth.

What does a baby with a cleft lip and/or cleft palate eat?

Babies with a cleft lip and/or cleft palate can be fed breast-milk, formula, or a mixture of both. Your primary healthcare provider can help you make the decision of what to feed your baby.

Usually babies with a cleft lip and/or cleft palate start spoon feeding with solids at the same time as babies that don’t have a cleft lip and/or cleft palate. Our cleft team, along with your primary healthcare provider, will help you decide when to start giving your baby solids.

What bottles are best to feed babies with cleft lip and/or cleft palate?

A cleft lip and/or cleft palate can make it hard for a baby to feed with a regular bottle system that you buy at the store. The Cleft Team at Children’s Colorado may suggest one of several bottles available specifically for babies with a cleft lip and/or cleft palate.

• The Medela Special Needs® Feeder (formerly called the Haberman Feeder) is made for babies with special feeding needs, including babies with facial differences. The nipple has flow rate lines that will let you adjust the milk flow to suit your baby’s feeding needs. It also has a one- way valve that keeps milk in the nipple. This special feeding system is available in different bottle and nipple sizes, including the Special Needs Feeder standard nipple and the mini Special Needs Feeder nipple.
• The Phillips Pigeon Bottle® is made for babies with special feeding needs including babies with facial differences . The Y- cut nipple has a thick and a thin side with a one- way valve that lets milk flow when the baby sucks and presses down on the nipple.
• The Dr. Brown’s Specialty Feeding System® includes a bottle and nipple with a special valve called the Infant-Paced Feeding Valve. This system assists with establishing flow when the baby sucks.

• The Mead-Johnson Cleft Lip/Palate Nurser is made for babies with special feeding needs including babies with facial differences. This specialty feeding system has a soft squeezable bottle with cross-cut nipple.

When your baby needs supplemental nutrition

It is important that all babies get enough nutrition for growth and development. Medical professionals will decide when this type of feeding is necessary, such as: 

• Some babies will need to have the calories of their formula or breast milk increased. When this is necessary, a very specific recipe is followed.
• Some babies need nasogastric tube (NG tube) feedings. This tube may provide supplemental feeding or feeding support for a short period of time when a baby is having a hard time taking their full feedings with a bottle. 
• Some babies need gastrostomy tube (G-tube) feedings. This tube is usually recommended when a baby needs supplemental feedings for a longer period of time or when babies have a lot of trouble with feeding. 

Helpful tips when feeding a baby with a cleft lip and/or cleft palate:

• Use a bottle specially made for babies with a cleft lip and/or cleft palate.
• Hold your baby in an upright, cradled position with your baby’s head well-supported.
• If there is a cleft of the lip, try to close the gap as much as possible with the nipple of the bottle or with the breast tissue if breastfeeding.
• If your baby needs extra help getting the milk, you can gently squeeze the bottle or the nipple (depending on the feeding system being used) in a pulse-squeeze pattern. If you give your baby extra help, it is important to time squeezing the bottle/nipple with the baby’s sucking activity and to closely watch your baby’s cues for signs that the milk is flowing too fast.
• Try to keep feedings less than 30 minutes, including time for burping. If feedings last longer than 30 minutes, your baby may be working too hard and burning too many calories.
• Your baby may need to be burped every ½ - 1 ounce, because he or she could be taking in extra air due to the cleft.
• It is important to have your baby weighed (naked) every week for the first month to make sure they are growing. It is also helpful to keep a log of your baby’s feedings to track how much they are eating.
• If your baby’s healthcare provider has questions or concerns, he or she can call the Children’s Colorado Cleft Nurse at 720-777-5364.

What about feeding your baby after cleft lip and/or cleft palate surgery?

After cleft lip surgery

Within a few days after surgery, most babies will be able to eat the way they were fed before the surgery. Sometimes babies will feed from a special TenderCare™ Feeder or from a syringe with Brecht® tubing for the first few days after surgery. These feeding devices will lower the chance of injury to the lip.

After cleft palate surgery

Within a few days after surgery, most babies will go back to drinking the same amount of liquid that they were drinking before the cleft palate surgery. Most surgeons will suggest feeding from a special TenderCare™ Feeder, a syringe with Brecht® tubing, an open cup, or a special sippy cup after surgery. It is important to talk with the Cleft Palate nurse about specific cups that are good for your infant/child to use after the cleft palate surgery.

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