Feeding a baby with a cleft
If you know during pregnancy that you are expecting a baby who has a cleft lip or palate, your provider will hopefully connect you with a cleft team. You can search for the closest one to you using the American Cleft Palate Craniofacial Association website.
I did my internship with the folks at Brenners. They are lovely.
If the cleft was a surprise at birth, ask your provider to connect you with one of these teams and go see them as soon as is feasible. Do not leave the hospital without a feeding assessment and solution.
With a cleft lip, you should be able to breast or bottle feed with minimal concerns. The breast tissue or bottle nipple usually fills the gap and allows your baby to create the suction necessary for feeding. It’s a good idea to ask the feeding specialist on site to observe a feed, and I would encourage you to request them to follow up on day four or five after your milk increases just to make sure all is well. If weight gain is good and you are feeling comfortable, a cleft lip alone should have minimal impact on nursing or bottle feeding.
A cleft palate is more complex. The cleft makes it difficult and usually impossible for your baby to effectively suck. It’s like trying to drink through a straw with a hole in it. Most babies will need to bottle feed with a compression-only bottle until they have their palate surgery. I’m most comfortable with the Dr Brown’s Specialty feeder because it still allows the baby to control flow. I’m not a big fan of the bottles that caregivers squeeze, since that takes away all learning and control from the baby.
Some parents are able to feed at the breast using a nipple shield to move the milk. Hand and/or pump expression is necessary to maintain milk supply whenever using a nipple shield, and close monitoring of weight gain is imperative with likely continued supplementation by specialty bottle or at-breast SNS (with a primed tube). Triple feeding can be exhausting, so unconditional support if you choose this route is key.
Babies with cleft palate are at higher risk for ear infections and speech/language delay in part caused by hearing difficulties because of the ear infections. Any breastmilk and particularly exclusive breastmilk feeding during the first 6 months of life has been shown to decrease ear infections and associated speech/language delays. (https://pubmed.ncbi.nlm.nih.gov/41042917/; Podcast summary)