Did you know that cleft lip and/or cleft palate can impact infant feeding? Clefts may impact feeding by influencing an infant’s ability to create an effective seal around a breast or bottle nipple, and interfering with an infant’s coordination of suck-swallow-breathe (SSB) to extract milk. This may also include nasal regurgitation—liquid coming out of nose—as well as excessive air intake, and coughing with feeds1,2. Ultimately, the cleft’s location and degree of involvement will cause varying levels of impact on feeding.
A feeding specialist, a lactation consultant, or both, can teach parents what to do to promote effective, quality feeding experiences with their infants. Understanding the basics of feeding with cleft lip or cleft palate can help any caregiver in an affected family.
Cleft Lip/Cleft Palate Feeding Impact
Cleft conditions hinder infant feeding in two main ways: the creation of an effective seal and latch; and milk extraction through suck-swallow-breathe coordination.
Creating an Effective Seal and Latch
Infants with cleft lip/cleft palate often demonstrate difficulty achieving adequate latch and oral seal around breast and bottle nipples. Additionally, infants with cleft palate will also have difficulty separating mouth and nose spaces due to the cleft opening. Although infants with cleft lip alone typically become successful breast or chest and bottle feeders, infants with cleft palate may require additional modifications and interventions to support successful feeding1.
Coordinating Suck-Swallow-Breathe: Milk Extraction
One of the most difficult aspects of infant feeding with cleft-lip/cleft palate is generating enough pressure in the mouth to extract milk from the breast or bottle nipple. An infant may achieve an adequate latch and seal with their lips around the bottle nipple or breast/chest tissue, but the seal does not continue within the mouth. This lack of separation between the mouth and nose cavities makes it difficult for the infant to extract milk and increases nasal regurgitation3. This leads to infants primarily using compression, rather than compression and suction, patterns to feed. This may look like an infant “clamping” or “biting” down on nipples. Additionally, infants with cleft lip/cleft palate secondary to a genetic syndrome or sequence (such as Pierre Robin sequence), often present with additional oral motor difficulties, making it harder to effectively feed1.
So, now that we understand how feeding may be impacted, what are some things to consider supporting feeding?
Cleft Lip/Cleft Palate Feeding Considerations
Breastfeeding or Chestfeeding
Infants with cleft lip alone can often become successful with breastfeeding/chestfeeding. Infants with cleft lip that extends to alveolar ridge (or, where the jaw meets the teeth sockets) may also achieve successful with breastfeeding/chest feeding, but generally require assistance from a lactation consultant or feeding therapist. Infants with a cleft palate, with or without lip involvement, may be able to breastfeed/chestfeed with some assistance, however, it is not likely to be effective enough to meet all nutritional needs. In these cases, using specialty bottles is often required.
Specialty Bottles
Choosing an appropriate bottle can make all the difference in promoting effective and successful infant feedings. What’s most important is choosing a bottle that allows for milk extraction through compression only (remember: these babies feed via clamping or biting), rather than requiring increased pressure in the mouth cavity. Dr. Brown’s® Specialty Feeding System does just that! It includes an Infant Paced Feeding Valve (also referred to as the blue one-way valve) which can be inserted into any narrow nipple flow level. While there are other specialty bottles available, Dr. Brown’s® bottle nipples have tested consistency in flow rates, which supports oral motor and swallowing coordination as well4.
Alternative Feeding Methods
Sometimes using a bottle can be difficult before initial cleft repair, especially if an infant has an underlying genetic or neurological implication. That is why using alternative feeding methods can be helpful4.
- Open Cup: Offer small sips of breastmilk or formula from an open cup. Make sure to read your infant’s cues, and pace based on their needs.
- Spoon: Offer breastmilk or formula from the side of a spoon. Infants may suck it off the edge.
- Syringe: Slowly drip breastmilk or formula into infant’s mouth via syringe. Pay close attention to avoid dripping too quickly or too far back in the oral cavity.
Other Considerations
In addition to strategies previously mentioned, there are a few other considerations when feeding infants with cleft lip/cleft palate.
- The infant may require more frequent burping.
- Increasing nipple pliability/flexibility or changing shape, size, or flow rate can improve bottle feeding.
- A supplemental nursing system (SNS) or nipple shields may be helpful for latching and milk extraction at the breast/chest.
Cleft lip and cleft palate may impact a baby’s feeding, but caregivers can learn how to support their growth and development. As you both continue the feeding journey, your infant’s skills will likely improve, leading to more positive, effective feeding experiences. Importantly, working with a feeding specialist and/or lactation consultant can help you work through these strategies and create an individualized feeding plan that is right for you and your baby.
Sources
- Arvedson, J., Brodsky, L., & Lefton-Grief, M. (2020). Pediatric swallowing and feeding: Assessment and management (4th ed.). Plural Publishing.
- Gailey, D. G. (2016). Feeding infants with cleft and the postoperative cleft management. Oral and Maxillofacial Surgery Clinics of North America, 28(2). https://doi.org/10.1016/j.coms.2015.12.003
- Masarei, A. G., Sell, D., Habel, A., Mars, M., Sommerlad, B. C., & Wade, A. (2007). The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Cleft Palate Craniofacial Journal. 44(3):321–8. https://doi.org/10.1597/05-185
- Pados, B.F., Park, J., & Dodrill, P. (2019). Know the flow: Milk flow rates from bottle nipples used in the hospital and after discharge. Advances in Neonatal Care, 19(1), 32-41. doi: 10.1097/ANC.0000000000000538