Breastfeeding Babies With Cleft Lip or Palate

Every new mother looks forward to a stress-free nursing experience. However, cleft lip and palate feeding problems can pose a very big challenge for breastfeeding mums. Despite the challenges, rest assured that cleft lip and palate feeding problems can be overcome. This article will guide you on how to do this by giving you information on cleft lip and cleft palate feeding techniques.

How do cleft lip and palate occur?  

Cleft lip and palate are both birth defects. They develop when the baby is still in the uterus. Between the 6th and the 10th week of pregnancy, the bones and tissues of a baby’s mouth, upper jaw and nose come together. 

If this doesn’t happen properly, they can end up with a cleft lip or a cleft palate. Or sometimes both. Breastfeeding babies with cleft lip and palate, thus becomes quite difficult. 

What is a cleft palate? 

A palate is the roof of your mouth. When you touch it with your tongue, you will notice that its front part if hard. Its back end, near the throat, meanwhile, is soft. 

When a newborn has a cleft palate, he will have an opening between the nose and the roof of his mouth. This opening can be from either the hard or soft part. Or from the entire mouth. 

What is a cleft lip? 

Most babies who are born with a cleft palate also end up with a cleft lip. A cleft lip is where the child has an opening in the upper lip. It usually happens on the top lip, although it can be unilateral or bilateral. 

In a unilateral cleft lip, the space or cut in the upper lip is only on one side. That cut can either be on the right or on the left. In bilateral cleft lip, you’ll notice the cut to be on both sides. You will see a slit in the middle of the nostrils. 

A newborn could have a cleft lip and cleft palate, or both. It mostly depends on two primary factors.  

What causes a cleft lip and palate?

While experts have not yet found the exact reason for a cleft lip, it occurs mostly due to two reasons. 

• Genetics: A cleft lip or cleft palate can be the result of genes. These get passed on from the mother or the father to the child. Studies reveal that researchers have uncovered many genes that cause cleft palate and lip. Three in particular including “T-box transcription factor-22 (TBX22), poliovirus receptor-like-1 (PVRL1), and interferon regulatory factor-6 (IRF6)” are linked to this condition. 
• Environmental factors: The second reason is environmental factors that affect the expecting mum. Between the sixth and 10th week, the baby forms parts of his or her mouth. But if the mother takes certain strong medicines, it can affect the baby’s development in the uterus. Also, if the expecting mother’s nutrition is not optimum, it can lead to a cleft lip and palate in the newborn. It can also happen if she drinks alcohol, takes illegal drugs or is diabetic. 

Cleft lip and palate feeding problems can be quite hard to overcome for breastfeeding mums. But it doesn’t mean you cannot give your newborn your own breast milk, or that you should give up trying. 

How does breastmilk help babies with cleft lip and palate? 

Remember that breastfeeding is crucial for your baby, and it has many benefits. 

• Breast milk contains antibodies that help the baby fight off viruses and bacteria.
• It lowers the baby’s risk of having asthma or allergies.
• Babies who breastfeed exclusively for the first six months have fewer ear infections, respiratory illnesses or bouts of diarrhea.
• Breastfeeding strengthens a baby’s immune system. It helps lower a baby’s chance of getting any infections.
• Breastfeeding promotes face and jaw development. Sucking at the breast exercises a baby’s facial muscles. 
• It also helps to create a strong bond between the mother and the child. 

On some days you may feel defeated and consider giving formula milk. But for babies with cleft lip and palate, formula feeding is not the best solution. Here’s why:

• Babies can end up with an ear infection. That’s because the Eustachian tube that goes from the back of the nose up to the ear fills up with milk.  
• Babies with a cleft lip and palate need extra love and care. Breastfeeding provides that comfort.
• Some babies have to undergo a surgical procedure to correct a cleft lip and palate. For such babies, breastmilk provides lysozyme and epithelial growth factors. These help to heal the wounds faster. Your soft nipple will not damage or hurt the baby’s newly-operated mouth. 

The next obvious step to understand is the way to nurse your baby and overcome cleft lip and palate feeding problems as well as learn some techniques. 

Cleft lip and cleft palate feeding techniques: How to breastfeed baby with a cleft lip?

Cleft lip and palate feeding problems can be tough to sort, and breastfeeding babies with cleft lip and palate may take some time. But by knowing the correct cleft palate feeding techniques, it is possible. It may also require assistance from experienced lactation experts and doctors. In such a condition, your baby will use a lot of his energy to take his feed. 

That’s mostly because he is not aware that he has a cleft lip and palate. And, breastfeeding is the only activity that might soothe him. As he gets older, he will learn to feed with the cleft lip till it is surgically corrected between the 9th or 12th month.

Until then you can try the following cleft palate feeding techniques:

• Breast compression: It is a method to stimulate an easy milk let down or ejection reflux. Once your baby latches on and starts breastfeeding (open mouth wide – pause – then close mouth), give him a few minutes. If he stops abruptly in the middle it means he is no longer breastfeeding. So slowly cup and squeeze your breasts between your fingers and your thumb to release the milk. 
• Breastfeeding position: While breastfeeding babies with cleft lip, make sure to keep the baby’s head close to the breast. In all of the positions – cross over, cradle, rugby as well as lying position – it is best to hold your breast in your baby’s mouth. 
• Skin-to-skin contact: Since cleft lip and cleft palate can obstruct breastfeeding, giving your baby skin-to-skin contact can make him feel comfortable. This also helps the baby to grow and develop faster. It also stimulates your baby’s feeding reflexes. 
• Be patient: If you are planning to get your baby’s cleft lip and palate surgically corrected, then it might be a good idea to practice patience while breastfeeding. On many days you will want to just hand him a bottle of formula milk. But avoid doing that. Instead, try to adapt to your baby’s changing needs. 
• Palatal obturator (dental plate): In many countries like Australia and US, doctors advise new mums to use a palatal obturator (dental plate). It is a prosthetic device made of an acrylic plate that covers the entire palate of the mouth. A paediatric dentist or orthodontist will custom-make this for your baby and fit it within the first two to three days of the child’s birth. You will have to be careful about the placement of your breast while using a palatal obturator. So it’s best to keep an open eye and mind about breastfeeding babies with cleft lip and palate.  

If none of these cleft palate feeding techniques work, then the best option is a surgical correction.  

What is the treatment for cleft lip and cleft palate? 

If some cleft palate feeding techniques just aren’t working, you can choose to go for the surgical operation. The treatment of a cleft lip and palate depends on the severity of the deformity. 

Surgery for a cleft lip and palate will ideally be performed within the child’s first year. In some cases, he may need additional reconstructive surgeries later on in life. 

During the cleft lip surgery, the doctor will take skin from both sides of the lip and stitch together its tissues and muscles. In a cleft palate surgery, the tissues and muscles of the palate are stitched together. In both cases, your baby will be given local anesthesia.  

Breastfeeding babies with cleft lip post surgery: What do you need to know?  

Once the cleft lip and palate surgery is over, you will have to be cautious about breastfeeding for the first few days. As your baby learns to cope with his new lip and palate, he will naturally take to breastfeeding. 

So here’s what you need to remember regarding cleft palate feeding techniques:

• Breastfeed as often: Most of you will produce enough milk to satisfy your hungry baby. Even after surgery, keep at it. While you may not need to produce extra milk, your baby may demand more after surgery. That’s because being on the breast feels secure and the breast milk will provide immunity for fast recovery.
• Regular expression: For some time until your baby recovers, you might not breastfeed as often. So in the meantime, make sure to express often. Also make sure to express milk during the night so it doesn’t slow down your supply. 
• Electric breast pump: Consider renting out or purchasing an electric breast pump. You can even get one with a double kit so you can express from both breasts at the same time. 
• Encourage let down reflex: A let down reflex or milk ejection is when your breasts naturally feel the need to let down milk. This often happens when you look at the baby, when you’re relaxed or when your baby cries for your milk. You can relax your body, especially your neck and chest and listen to relaxing music as well as practice yoga for that purpose. 
• New breastfeeding equipment: If you are unable to breastfeed after the surgery, you can try different equipment to aid your feeding. You can use a syringe to feed your baby. You can also try spoon feeding and nipple shields. There are several bottles for kids with cleft lip and palate as well. For instance, the Medela Special Needs bottle helps a baby with a poor suck to feed easily. 
• Keep an eye on other issues: Many babies with cleft lip also suffer from colic or wind problems. In such cases, feed your baby in the upright position. Burp after each feed and carry him in an upright position as well. And don’t forget to massage your baby every day. Regurgitation or vomiting of milk is also common in babies with a cleft lip and palate. Ideally, this will stop after surgery, but if it persists, visit your lactation consultant. 

Breastfeeding babies with cleft lip and cleft palate requires a lot of patience. In addition, you will have to be extra vigilant about your baby’s needs, especially if he needs surgery. But remember even if it is difficult at first, you are not alone. 

There are many other new mums who are going through the same journey as yours. So stay positive and enjoy the bonding time with your baby.  And we hope this article, including tips on cleft lip and cleft palate feeding techniques, has been helpful. 

Sources: breastfeeding.asn

Related to this article on cleft palate feeding techniques: Tongue tie in babies: Everything you need to know about this condition