A cleft lip is an opening in the upper lip, and a cleft palate is an opening in the roof of the mouth (palate). Cleft lip and cleft palate (orofacial clefts) are birth defects that occur when the upper lip or the palate does not develop completely before birth.

In babies with a normal lip and palate, the seal between mouth and breast creates negative pressure that draws milk out of the breast and down the throat with each suck. Babies with cleft lip or cleft palate may have trouble getting enough milk out of the breast because they are unable to form a good seal. Working with a breastfeeding specialist (lactation consultant) can help you overcome this challenge and make sure that your needs and your baby's needs are being met.

How does breastfeeding benefit my baby?

• Breast milk supports your baby's disease-fighting system (immune system). Breastfeeding can help protect your baby from infections that are common among babies with cleft lip and cleft palate, such as ear infections.
• Cleft lip and cleft palate are often repaired with surgery during your baby's first months. Breastfeeding can help your baby stay healthy for surgery and can prevent infections after surgery.
• Breastfeeding is calming and soothing for mother and baby. The skin-to-skin contact promotes bonding between mother and baby.
• The breast is soft and flexible, and it can mold to your baby's lip and mouth. These qualities make up for abnormalities of the lip and mouth.
• Breastfeeding allows your baby to have control over the flow of milk. Milk flow can be hard to control with bottle feeding.
• Breastfeeding does not irritate tissues in your baby's mouth and nose the way formula can.

What actions can I take to help my baby to breastfeed?

• Try holding your baby in different positions while your breast is still soft. It is often easier to feed babies with cleft palates when they are in a semi-upright position. This is because milk is less likely to leak into their noses.
• Use your thumb or breast to help fill in the opening in the lip. Doing this will help form a seal around your breast.
• Some babies have cleft lips or cleft palates that are so large that they prevent the babies from being able to nurse effectively. If this is the case for your baby, start pumping your milk right away to keep up your milk supply. This will allow you to feed your baby only with breast milk (exclusively breastfeed) after he or she has had surgery.
• If your baby cannot latch on well to your breast, use a bottle, cup, or spoon to feed him or her breast milk.
• Try using feeding tube devices or specialty bottles with soft, flexible nipples to make sure that your baby gets enough milk. Ask your lactation consultant or your baby's health care provider about using these devices.

Breastfeeding tips and recommendations

• Work with a lactation consultant to find positions, equipment, and breastfeeding strategies that work best for you and your baby.
• Make sure your baby is getting enough milk by counting his or her wet diapers and bowel movements. Signs that your baby is getting enough milk include:
  • Wetting at least 1 or 2 diapers during the first 24 hours after birth.
  • Wetting at least 5 or 6 diapers every 24 hours for the first week after birth. The urine should be pale yellow by 5 days after birth.
  • Wetting 6–8 diapers every 24 hours as your baby grows.
  • Producing a healthy amount of stool (feces):
    • By the time your baby is 5 days old, he or she should produce at least 3 stools in a 24-hour period. The stools should be soft and yellow.
    • By the time your baby is 7 days old, he or she should produce at least 3 stools in a 24-hour period. The stools should be seedy and yellow.
• Make sure your baby is gaining a healthy amount of weight. Talk with your health care provider or lactation consultant about how much weight your baby should be gaining.
• Talk with a lactation consultant if your baby does not get enough milk from breastfeeding alone. It may be possible to breastfeed part of the time and supplement feedings with donated milk or formula.

Where to find more information

• La Leche League: llli.org
• American Academy of Pediatrics: healthychildren.org
• Office on Women's Health: womenshealth.gov/breastfeeding

Contact a health care provider if:

• Your baby is older than 5 days and:
  • Does not seem satisfied after feeding at the breast.
  • Is not producing at least 5 or 6 wet diapers every 24 hours.
  • Is not producing at least 3 stools every 24 hours.
• Your breasts become large and painful (engorged).

Summary

• Babies with cleft lip or cleft palate may have trouble getting enough milk out of the breast. This is because it is hard for the mouth to form a good seal around the nipple.
• Work with a lactation consultant to find positions, equipment, and breastfeeding strategies that work best for you and your baby.
• Try holding your baby in different positions while your breast is still soft. It is often easier to feed babies with cleft palates when they are in a semi-upright position. This is because milk is less likely to leak into their noses.