Can You Still Breastfeed After Cleft Lip or Palate Repair? A Comprehensive Guide
Breastfeeding can be challenging for any new parent, but it presents additional hurdles for those whose babies are born with a cleft lip or cleft palate. These conditions, among the most common birth defects, occur when the upper lip or the roof of the mouth does not form properly during pregnancy. After cleft lip repair or cleft palate repair, many parents wonder if they can still breastfeed. The good news is that breastfeeding can still be possible, though it may require extra effort, specialised support, and the right feeding techniques.
Understanding Cleft Lip and Palate
Before diving into breastfeeding, it’s important to understand the differences between a cleft lip and a cleft palate. A cleft lip is a gap in the upper lip, while a cleft palate is a gap in the roof of the mouth, which can affect the soft palate, hard palate, or both. The gap can affect your baby’s ability to create enough suction when feeding, making it difficult for them to latch onto the breast or bottle. Depending on the type of cleft, babies may have difficulty feeding, which can lead to poor weight gain or other feeding issues.
Feeding Before Cleft Surgery
Babies with a cleft lip or palate often face unique challenges when feeding, and they may require speciality bottles or different feeding methods. Many babies with a cleft palate cannot breastfeed directly because they can’t create enough suction to extract enough milk from the breast. For these babies, a special bottle, such as Dr. Brown’s soft squeezy bottle is designed to help the baby get enough milk without requiring much suction.
In some cases, syringe feeding or spoon feeding may be necessary if the baby has severe feeding difficulties. A cleft team, which may include a cleft nurse specialist, lactation consultants, and feeding therapists, can provide guidance on the best feeding plan for your baby.
Many parents find it easier to breastfeed a baby that has a cleft of the lip but not of the palate. They can often successfully ‘plug’ the gap of the cleft by gently pulling the two sides together around the breast, which can create more suction. When there is a cleft of the palate, however, creating enough suction to feed successfully can be much more difficult. I remember my cleft nurse explaining to me that it’s like when there’s a hole in a straw. Even if the hole is very small, it’s very difficult to suck up the liquid. All cleft babies are different of course, meaning that some will successfully be able to breastfeed, while others will not.
Breastfeeding After Cleft Lip or Palate Repair
Once your baby has undergone cleft lip repair or cleft palate repair, it is often possible to begin breastfeeding again if you were breastfeeding before the surgery. However, it may not happen immediately and could take some time and extra help. Surgery closes the gap in the baby’s mouth and/or palate, which should in theory improve their ability to latch onto the breast. However, the healing process after surgery means that the delicate tissue in the mouth needs time to recover, and your baby may experience too much pain and discomfort in the hours and days afterwards to want to breastfeed.
Your plastic surgeon or cleft team will provide guidance on when it is safe to resume breastfeeding, although they will usually say it’s safe to try straight away after the surgery.
Preparing for Breastfeeding Post-Surgery
The main thing to remember is that your baby may not feel able to or want to breastfeed straight after their surgery, even if they were happy to breastfeed before. Although this can be a very distressing time for both the parents and the baby, it’s important to remember that it may just take a little time for them to be healed enough to resume breastfeeding. While your baby is recovering, it’s a good idea to use a breast pump to maintain your milk supply. A lactation consultant or lactation support provider can be a great resource for ensuring you produce enough milk during this time.
As well as regularly expressing milk to keep up your supply, keep experimenting with different positions to help your baby latch comfortably and ease the transition after surgery. A semi-upright position or holding your baby in a way that avoids putting much pressure on the baby’s nose or healing lip can help. Babies may initially struggle with direct breastfeeding after surgery, so offering a bottle or continuing with bottle feeding will possibly be necessary in the first-week/s post-surgery.
If your baby is struggling to suck from their regular bottle, try going back to using a soft squeeze bottle to literally squeeze milk into their mouth without them needing to suck. I wish I had been given this advice after my son’s surgery as it would have saved a lot of tears and frustration from both of us.
Challenges and Solutions
Some babies may still have trouble breastfeeding for a long time after surgery due to lingering issues with creating suction or discomfort as they get used to the new feel a sensation of their repaired mouth. Feeding issues such as difficulty forming a proper latch or creating much suction can persist, especially if the cleft affects the soft palate or hard palate. Babies with a repaired cleft palate may experience feeding issues related to their tongue and its movement against the breast tissue.
It took two weeks for my son to start breastfeeding again after his surgery. Some babies never manage to go back to it afterwards, which can be very upsetting for the breastfeeding parent. It’s therefore best to prepare yourself for this to be the possible outcome before your baby goes in for cleft repair surgery. If breastfeeding directly is not possible, you can continue bottle feeding with a speciality bottle or nipple system that suits your baby’s feeding needs. It might be frustrating to begin with and you and your baby both adapt to a new way of feeding, but there is a lot of help out there via hospital cleft teams and specialist cleft nurses to help. If your baby is older than six months when they have their cleft repaired, you may find that they are reaching the stage where they are ready to start transitioning onto a sippy cup and away from bottles anyway.
You may need to work with cleft specialist healthcare professionals to ensure your baby is getting proper nutrition after their surgery, especially if they are finding feeding difficult (either milk or solids or both).
My son didn’t take particularly well to eating purees and solid food at six months, and I always put this down to the fact he had a cleft palate. As a result of this, he was still getting most of his nutrition from breastmilk by the time he had his surgery at eight months, which made it very difficult when he wasn’t able to breastfeed for a fortnight afterwards. Essentially, he just wasn’t eating much at all and on the advice of our cleft nurse, we eventually had to force-feed him formula from a squeezy bottle as he was starving hungry.
If you are struggling with feeding your baby and worrying they are not receiving adequate nutrition after their surgery, don’t hesitate to call your cleft team for advice. You may also need to work with a speech pathologist (who is part of the craniofacial team) to address any lingering feeding problems and ensure your baby is getting adequate nutrition.
Addressing Weight Gain and Nutrition
Maintaining your baby’s birth weight and supporting their growth is crucial. Babies with a cleft may struggle with poor weight gain due to feeding issues, particularly when they are first born and possibly again after their cleft repair surgery. However, with the right support and feeding techniques, you can meet their nutritional needs. Whether through breastfeeding, bottle feeding, or a combination of both, it’s important to monitor their weight gain and overall health. Even if there are bumps in the road, your cleft team and child health specialists will help to monitor and track their progress, ensuring they receive enough nutrition for healthy growth.
In some cases, formula milk may be recommended as a supplement if your baby is not gaining enough weight. However, even if formula milk is introduced, it doesn’t mean you have to stop breastfeeding. Many parents find that using both breast milk and formula can be an effective way to ensure their baby gets the amount of milk they need while still benefiting from the antibodies and bonding that breastfeeding offers. Even if your baby receives just a little breastmilk after they’re born/after they’ve had cleft surgery, this is still highly beneficial, and if they are unable to breastfeed at all, then expressing milk for them to have in a bottle can be an option.
Speech and Development Concerns
One of the long-term concerns after cleft palate repair is the potential for speech problems. This is why your cleft team will usually include speech and language pathologists who will monitor your child’s speech development as they grow. Feeding therapists and speech pathologists can sometimes play an important role in helping your child transition to solid foods and develop proper oral motor skills. Don’t hesitate to go to them for help if you are struggling with any aspect of your cleft child’s care, or if you are concerned about their development in any way.
Getting the Right Support
Every cleft case is unique, and your child’s ability to breastfeed or bottle-feed will depend on the type of cleft, the extent of the surgery, and their individual needs. The cleft team, including medical professionals such as the plastic surgeon and specialist cleft nurses, is your best resource. These experts can provide guidance tailored to your child’s health and development, including tips on breastfeeding positions, feeding methods, and the right feeding plan.
The Cleft Lip and Palate Association (CLAPA) can also be a valuable resource. They provide helpful information on feeding issues and support for parents navigating this complex journey, as well as providing specialist feeding equipment for families expecting a baby with a cleft.
Conclusion: The Best Way Forward
Breastfeeding after cleft lip or cleft palate repair can be possible, but it may take extra help, patience, and the right tools. While some babies can breastfeed directly after surgery, others may need a special soft bottle or a combination of breastfeeding and bottle-feeding to get the nutrition they need. With the support of the specialist professionals in your cleft team, you can find the best way to ensure your baby gets enough milk and thrives as they grow.
Getting my baby through his cleft lip and palate surgery when he was eight months old was one of the toughest experiences I’ve had. The fact he couldn’t breastfeed for two weeks after his surgery made it all the harder, but with perseverance and the help of squeezy bottles, he did eventually go back to it. While the experience was very hard for all of our family, we definitely came out of it stronger by the end of it, and I hope that you and your baby will too.
My Cleft Baby Breastfeeding Journey Video Diary
In this video I show how I managed to breastfeed my baby born with cleft lip and palate. I hope you find it useful:
https://www.youtube.com/watch?v=Ix2EUhSZhs8
WHY NOT BOOK A CLEFT-SPECIALIST HYPNOBIRTHING COURSE?
Are you expecting a baby with a cleft lip/palate and feeling anxious? If you would like to book a hypnobirthing course to help relieve some of that anxiety with someone who has already been through the cleft lip and palate journey, why not book a hypnobirthing course with me? I teach online so it doesn’t matter where you are in the world.
Check out my own cleft hypnobirthing journey and the hypnobirthing course I now teach to others by clicking the following link:
https://enjoyeveryminute.co.uk/category/hypnobirthing
Further links and Resources:
https://laleche.org.uk/breastfeeding-a-baby-with-a-cleft-palate/
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