Feeding a Baby with a Cleft Palate or Lip
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Feeding a baby can be a daunting task for any new parent, but it can be especially challenging when your baby has a cleft palate. A cleft palate occurs when the roof of the mouth does not fully form in utero, which leaves a gap or opening in the tissue connecting the nose and the mouth. This can affect your baby’s ability to eat and drink properly because they are not able to get the proper suction to pull the milk from a nipple. It is similar to trying to drink from a straw that has a crack in it.
In general, the nutrition guidelines for feeding a baby with a cleft palate are the same as for any other baby, and a baby with a cleft palate can bottlefeed and eat solid foods but will need special feeding techniques and bottles. As a registered dietitian specializing in infant feeding, my goal in this post is to provide you with some basic recommendations and tips for feeding a baby with a cleft palate.
What is the difference between a cleft lip versus a cleft palate?
According to the American Academy of Pediatrics (AAP), a cleft palate is one of the most frequently occurring congenital anomalies in babies. Approximately 1 in every 600-700 babies is born with a cleft lip and/or palate.
It is most common to see a baby with both a cleft lip and a cleft palate. The difference is that a cleft palate is a hole in the roof of the mouth, while a cleft lip refers to a gap in the baby's upper lip that may occur on one or both sides (called a bilateral cleft). A baby can be born with just a cleft lip, just a cleft palate, or a combination of both.
Babies born with a cleft lip are frequently detected during prenatal ultrasounds; however, cleft palates alone are more often diagnosed once a baby is born.
Once a diagnosis is made, either prenatally or postnatally, the parents of the baby will be referred to a specialist team to learn more about specialized care. Many specialists will work with the family, including a craniofacial surgeon, speech therapist, genetic counselor, pediatric dentist, audiologist, and registered dietitian.
Most cleft lips are surgically repaired at around 3 months of age. Cleft palates are generally surgically repaired between 10-14 months of age.
Parents of babies with cleft lips and/or palates will work with their team of specialists before and after surgery to learn how to best feed their babies.
How do I bottlefeed my baby with a cleft palate?
Babies born with an isolated cleft lip may be able to breastfeed and bottlefeed from a normal bottle with assistance from a feeding specialist to help with proper positioning. However, when feeding a baby with a cleft palate, a special type of bottle called a cleft palate bottle is always recommended*.
Cleft palate bottles have a specially designed nipple that allows the milk to flow more slowly and in a controlled manner, which will help reduce the risk of choking and ensure that your baby has time to swallow properly.
There are several types of cleft palate bottles available, but most have a longer nipple with a wider base and a special valve that controls the flow of milk. Some bottles also have a special vent that helps reduce air intake and help prevent colic. The most common cleft palate bottles are the Enfamil Cleft Palate Nurser, the Haberman Special Needs Bottle*, and the Pigeon Bottle*.
If you are unable to obtain a specialty bottle, you can also make a “crosscut” nipple by cutting an “X” with a sharp knife at the nipple opening to allow milk to flow more easily.
When using a cleft palate bottle, it is important to position your baby properly to make sure they can swallow properly. Hold your baby in an upright position with their head and neck supported. Slightly tilt their head back so that the milk can flow to the back of your baby’s mouth, away from the nose.
Babies with a cleft lip or palate will often have milk come out of their nose, which is called nasal regurgitation. This is common and not harmful. When this happens, try placing your baby in a more upright position and giving them a short break to clear the milk, either by coughing or sneezing. Avoid suctioning the milk from their nose frequently, as this can lead to negative associations with feeding.
Babies with a cleft palate are also more likely to swallow air than other babies. It is best to burp them throughout the feeding, especially if they show signs of discomfort, such as becoming fussy during feeding or spitting up.
It may take some time for a baby with a cleft lip or palate to learn to feed properly from a bottle. It is important to be gentle and patient when feeding - try to allow them plenty of time for them to eat at their own pace.
That being said, feeding a baby with a bottle should take no longer than 30 minutes. If your baby is struggling with feeds lasting longer than 30 minutes or showing signs of other swallowing problems, such as choking or excessive spit-up, please contact your pediatrician or feeding specialist for further evaluation.
Can I breastfeed my baby with a cleft palate?
The current research shows that most babies with a cleft palate cannot successfully obtain adequate calories from breastfeeding alone. Babies with a cleft palate may look like they are latching and nursing well; however, they are not able to maintain the suction needed to pull the nipple to the back of the mouth for proper expression of breast milk.
This can understandably be hard news to hear for a parent who was hoping to breastfeed their baby. It is okay to mourn this loss! But remember, you can still spend quality time with your baby while feeding by making plenty of eye contact and offering skin-to-skin contact.
When possible, it is still recommended to provide your baby with expressed breast milk as the main source of nutrition until 6 months old. Once your baby is feeding well with a bottle, you can try letting your baby suckle for non-nutritive purposes from the breast if you prefer.
According to the American Cleft Palate-Craniofacial Association, “non-nutritive sucking exercises stimulate important muscles in your baby’s mouth and tongue and can facilitate the bonding experience.” It may also help increase milk production for those moms who are pumping breast milk.
How should I offer solids to a baby with a cleft palate?
When it comes to introducing solids to a baby with a cleft palate, there are a few things to keep in mind. First, it is important to make sure your baby is showing signs of readiness to start solids, which is usually around 6 months of age. These signs include the ability to remain seated upright with minimal support, holding the neck/head relatively steady, picking up an item and putting it to their mouth, and showing an interest in foods.
Second, babies with a cleft palate may have some food come out of their noses, similar to when they are drinking milk from a bottle. This is normal and shouldn’t be too bothersome to your baby. Try to avoid wiping their face repeatedly and cleaning their nose often to remove the food during meals, as this can make mealtime an unpleasant experience.
If you notice that your baby has trouble with a particular texture getting lodged in their cleft, you can try to thin the texture of a puree by adding more liquid or giving your baby more frequent sips of water after swallowing.
When first introducing foods to your baby, choose soft foods that are easy to swallow, which can either be a puree or soft mashable food. A few examples include eggs, yogurt, pureed butternut squash, and applesauce.
Until your baby has molars and has had plenty of experience chewing and swallowing, avoid any hard, round foods that are the size of a child’s airway. A few examples of the top choking hazards for kids under age 4 include hard candies, popcorn, grape tomatoes, grapes, hot dogs, marshmallows, raw carrots, whole nuts, and globs of peanut butter.
As with all babies, it is also important to introduce allergens early and frequently, starting at about 6 months of age. Feeding babies the top allergenic foods early and often during infancy not only helps reduce the risk of the development of food allergies but also allows us to identify food-allergic babies. The top allergens to introduce include peanuts, milk, eggs, fish, shellfish, tree nuts, wheat, sesame, and soybeans.
If you are getting ready to start your baby on solids, download my FREE Baby-Led Feeding Essential Checklist to ensure you have everything you need to get started.
Can babies with a cleft palate do baby-led weaning?
Yes! Because eating solid foods does not require suction, most babies with a cleft palate are able to eat and swallow foods without any issues, as long as the foods are prepared appropriately for the developmental stage of the baby.
This means that babies around 6-8 months of age who pick up food with the palm of their hands (also called the palmar grasp) are fed longer strips of soft, easily mashable foods such as ripe avocado, steamed sweet potato, or banana. Closer to 9 months of age, once a baby is able to pick up foods with their thumb and forefinger (also called the pincer grasp), it is okay to feed smaller pieces of soft foods that are cut to the size of a chickpea.
If you want more information about baby-led weaning, check out my online course for parents, based on my best-selling book, which will walk you through starting solids using a baby-led approach.
Can babies with a cleft palate drink from an open cup?
Absolutely. Most babies with a cleft palate cannot drink well from a sippy cup or a straw cup because they are not able to create the suction needed to draw fluid out. But babies with a cleft palate are often instructed by their feeding therapist to practice drinking from an open cup before their surgery. In fact, even after a baby has corrective surgery, it is not recommended to suck for the first few weeks post-surgery to allow the face to heal, which means an open cup is ideal for drinking.
Giving your baby sips of water from an open cup after meals will also help to remove any food particles left in the mouth after eating, which can be a more significant issue in babies with a gap in the roof of their mouth.
Red flags to watch for when feeding a baby with a cleft palate
Most babies with a cleft palate are able to grow and gain weight well in the first 6 months while using an appropriate bottle that does not require suction. If a caregiver is not using the appropriate bottle, there is a risk that the baby will not be able to get enough milk which can cause dehydration. It is important to monitor weight gain as well as adequate wet and dirty diapers.
Once introduced to solid foods, most babies with cleft palates can begin to eat as any other baby would, as long as they are developmentally on target. Some babies with cleft palates have syndromes that delay their development. This is why it is very important to wait until a baby is showing signs of readiness to begin feeding solids.
Quick Tips for Feeding a Baby with a Cleft Palate
Feeding a baby with a cleft palate can be challenging, but there are several tips and techniques to help make the process easier and more comfortable for the baby and the parent.
Take your time: Feeding a baby with a cleft lip or cleft palate can take a little longer; try to stay calm, patient, and gentle as your baby is learning to feed
Be mindful of air intake: Babies with a cleft lip or palate are more prone to swallowing air, which can be uncomfortable; using a special cleft palate bottle with a vent and burping frequently can help reduce this
Nasal regurgitation is normal: Do not be alarmed if milk or foods come out of the nose; most babies are not bothered by a small amount and can quickly recover with a sneeze; if your baby has a large amount of milk coming from the nose, tilt their body forward slightly so that gravity can help it drain
If you have further questions about feeding your baby with a cleft palate or lip, please check out the American Cleft Palate-Craniofacial Society (ACPA). The ACPA Family Resources also offers support online and by phone (919-933-9044 extension 206).
Check out my blog for more tips, recipes, and recommendations about feeding your baby. If you're looking for personalized nutrition support for your babies or kids, I am currently accepting new clients in my virtual private practice and would love to work with you. Please comment below with any questions. Thanks for reading!