Breastfeeding the Infant with a Cleft Lip and/or Palate
by Anne Eglash MD, IBCLC, FABM
According to the Academy of Breastfeeding Medicine’s recent update on their protocol regarding breastfeeding the infant with a cleft lip and/or palate, approximately 1-3/1000 infants will be born with a cleft lip and/or cleft palate. Of these infants, approximately 50% will have a combined cleft lip and palate, 30% an isolated cleft palate, and 20% an isolated cleft lip.
The main difficulty with a cleft lip and palate is the difficulty in sealing the oral cavity to generate enough suction in order to extract milk. The protocol recommends that all families who are breastfeeding or providing breastmilk for an infant with a cleft have support and ongoing care with a board certified lactation consultant.
- A nipple shield should be used for infants with a cleft lip, in order to generate adequate suction.
- Infants with a cleft of the soft palate (and not the hard palate) can reliably generate adequate suction.
- Late preterm infants with a small cleft palate will typically generate less suction than a term infant with a small cleft palate.
- Using a palatal prosthesis for infants with a cleft palate will likely facilitate the ability to transfer milk well at the breast.
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This is a very practical guideline for professionals and families who are managing infants born with a cleft lip and/ palate.
There is no role for nipple shield use among infants with a cleft lip. Proper support at the breast to create a seal is essential for these infants to gain sufficiently at the breast.
Most infants with a cleft soft palate have difficulty generating adequate suck pressures to breastfeed effectively, similar to those with a cleft hard palate. Mature infants with a very small cleft palate may be somewhat successful with feedings at the breast. A palatal prosthesis is not expected to enable an infant with a cleft palate to breastfeeding successfully.
Families who have a cleft lip/palate diagnosed prenatally or immediately after birth need anticipatory guidance on feeding over time, and should be followed by a lactation consultant not only to support the mother who may be exclusively pumping, but also to help with positioning and latching the infant with a cleft lip and/or very small cleft palate.