Cleft palate

Can my baby breastfeed with a cleft palate?

Babies born with a cleft palate have a split in the roof of the mouth. Generally, they cannot create the vacuum needed to latch onto a breast and get milk. If the baby can’t breastfeed and the mother wants to provide breast milk, she needs to express. Supplements need to be given using a feeding tool that does not rely on the baby creating suction. This may be a special type of nipple or a soft-sided bottle that allows the caregiver to squeeze the milk into the baby’s mouth. This process can pose challenges and mothers and babies benefit from extra support. One type of cleft palate is a submucous cleft. It is hard to see and may only be diagnosed long after birth. It can cause feeding problems, difficulty swallowing, a nasal voice, and chronic ear infections. Some babies are born with cleft lips. Depending on the severity, they may be able to breastfeed.

A) Describing clefts

Baby with a cleft palate.

Babies may be born with facial conditions that affect latching and breastfeeding. Such conditions include cleft palates and lips (Madhoun 2019).

The palate is the roof of the mouth. It has two parts: the hard palate nearest the teeth and the soft palate farther back in the mouth. Cleft means split, so a cleft palate is a split palate.

There are various types of cleft palates (Boyce 2013). Clefts can occur in the hard palate or the soft palate. There may be one (unilateral) or two (bilateral) clefts. Most are obvious when looking at the baby’s face and in the baby’s mouth, but some, such as a submucous cleft palate, can be easily missed. Babies may also have a cleft lip. 

B) Cleft of the hard and soft palate

The black area seen at the back of the baby's mouth is a cleft of the soft palate.

Babies with a cleft of the hard and soft palate cannot create the vacuum needed for latching and getting milk from the breast.

As the baby can’t breastfeed, the mother needs to express if she wants to provide breast milk. All replacement feeds must be given with a feeding tool that does not rely on the baby creating vacuum. A special type of nipple such as a Haberman Feeder or a soft-sided bottle that allows the caregiver to squeeze the milk into the baby’s mouth are commonly used.

A variety of health-care providers, including surgeons and speech and language practitioners, are usually involved in the care of a baby with a cleft palate. Breastfeeding specialists, in particular, can be very helpful (Lopez-Bassols 2021; Gottschlich 2018).

C) Submucous cleft palate

With a submucous cleft, the baby is missing bone in the middle of the hard palate or has missing or abnormal muscles in the soft part of the palate. Because the defect is covered by the lining of the mouth (submucous), it is hard to see and may require ultrasound testing to identify. As a result, these may only be diagnosed long after delivery (ten Dam 2013).

Signs of a submucous cleft include:

  • An underdeveloped, missing, or double uvula (the little fleshy piece at the back of the mouth)
  • A pale blue line along the middle of the soft palate
  • A short soft palate
  • A palate that may feel abnormal:
    • An indentation or notch in the back edge of the hard palate
    • A weak area in the middle of the soft palate

A submucous cleft palate can cause problems including:

  • Feeding problems
  • Difficulty swallowing
  • A nasal voice
  • Chronic ear infections

D) Cleft lip

This baby has a cleft lip and breastfed without problems.

Lips may also be divided and are called cleft lips. Depending on the severity, babies with a cleft lip may be able to breastfeed (Alperovich 2017). Their growth should be closely monitored in the first few days after delivery to ensure they are taking in enough milk and growing well.

Cleft lips are often repaired with surgery three to six months after delivery. Babies should be encouraged to breastfeed afterward as their pain allows (Matsunaka 2019).

References

Alperovich M, Frey JD, Shetye PR, et al. Breast Milk Feeding Rates in Patients With Cleft Lip and Palate at a North American Craniofacial Center. Cleft Palate Craniofac J. 2017 May;54(3):334-337
 
Boyce JO, Reilly S, Skeat J, et al. ABM Clinical Protocol #17: Guidelines for Breastfeeding Infants with Cleft Lip, Cleft Palate, or Cleft Lip and Palate-Revised 2019. Breastfeed Med. 2019 Aug 13
 
Gottschlich MM, Mayes T, Allgeier C, et al. A Retrospective Study Identifying Breast Milk Feeding Disparities in Infants with Cleft Palate. J Acad Nutr Diet. 2018 Jul 11. pii: S2212-2672(18)30740-8
 
Lopez-Bassols I. Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate. J Hum Lact. 2021 May;37(2):419-424

Madhoun LL, Crerand CE, Keim S, et al. Breast Milk Feeding Practices and Barriers and Supports Experienced by Mother-Infant Dyads With Cleft Lip and/or Palate. Cleft Palate Craniofac J. 2019 Oct 9:1055665619878972
 
Matsunaka E, Ueki S, Makimoto K. Impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: A systematic review. J Craniomaxillofac Surg. 2019 Apr;47(4):570-577
 
ten Dam E, van der Heijden P, Korsten-Meijer AG, et al. Age of diagnosis and evaluation of consequences of submucous cleft palate. Int J Pediatr Otorhinolaryngol. 2013 Jun;77(6):1019-24