1. What to expect
The kind of cleft your child is born with will affect the way he or she breastfeeds. Knowing what other parents have achieved is helpful in formulating realistic feeding expectations for breastfeeding for your cleft affected child, however, every child is different, and every child/parent/family is different and therefore it is important to find a solution that works for you, your child and your family.
Generally, babies with a cleft lip can breastfeed without any major problems1,2,3,4. Mothers often recount general breastfeeding difficulties such as engorgement, perceived insufficient milk supply, lack of support and information (or outright criticism!)
It’s important to get off to an optimal start, get help to ensure that the baby has a good latch, you may need to experiment different positions, be careful that the baby is draining all regions of the breast (you may need to alternate positions to ensure this) in order to avoid engorgement – and use strategies that maximise milk supply (link).
Many experts consider it unlikely that a baby with a cleft of the soft palate can breastfeed fully1,4, , but some mothers have managed to do so. Ellen O’Grady, recounts in the now out of print LLL booklet5 how she simultaneously breastfed her twins, one cleft affected and one not. Another mother recounts her experience on youtube (http://www.youtube.com/watch?v=BpqqYQlKDeA)6. A mother in Italy recounts that she had an optimal antenatal course that prepared her for breastfeeding – she mentions that she got off to a good start and had been instructed on how to maintain an abundant milk supply, both during her antenatal classes and post-partum widwife support.
Breastfeeding fully with a cleft of the hard palate or a complete cleft lip and palate is also considered unlikely4, yet, in one hospital in Thailand, there is a successful breastfeeding programme for babies with a complete cleft lip and palate7. There are documented cases of babies with a complete cleft lip and palate (including my own) who have been partially breastfed/bottle fed breast milk up until cleft repair and then transitioned to the breast only (plus solids, as cleft repair is not generally done prior to 5 1/2 – 6 months of age). This is currently a rare occurrence, but I am convinced that at least partial breastfeeding, up to and, at times beyond, palate surgery, would be a more easily obtainable result, and a more frequent occurrence, if all cleft families received adequate breastfeeding information and support.
The baby with a cleft palate or complete cleft lip and palate, can learn to latch on. The baby can be supplemented at the breast with a plunger style supplementer or gravity feeder. Some mothers have found it useful to alternate breast and bottle at the same feed, others have bottle fed baby first, then finished off the feed at the breast. Latching baby on at the breast while that bottle warms, is another strategy.
Once the baby has had the palate repaired, there is a chance that the baby will then be able to breastfeed autonomously. This does not always happen; it will depend in part on the timing of the operation (some hospitals operate as early as 5-months), character of the baby (some babies are more determined than others to breast feed), and many other factors. If the baby does learn to breastfeed autonomously, then you may enjoy many many months, if not years, of enjoyable breastfeeding beyond that.
Further reading ‘Getting off to a good start’
1. Herzog-Isler C., ‘Breastfeeding a baby with cleft lip and/or palate’, (CD) Atti della XI Giornata dell’Allattamento, LLL, Trevi, 15 Maggio 2010.
2. Morbacher, N., Kendall-Tackett, K., Breastfeeding Made Simple, 2 ed. New Harbinger publications, 2010
3. Newman, J., Pitman, T., The Ultimate Breastfeeding Book of Answers, Three Rivers Press, USA, 2006 p.250-251
4. Morbacher, N., Breastfeeding Answers Made Simple, Hale publications, 2010
5. Grady,E,. Nursing my baby with a cleft of the soft palate, Schaumburg, Illionois, La Leche League International, 1983 (out of print)
6. Cleft Palate Breastfeeding http://www.youtube.com/watch?v=BpqqYQlKDeA (published on Youtube 19 May 2013, accessed 19.07.2013)
7. Pathumwiwatana P, et al. The promotion of exclusive breastfeeding in infants with complete cleft lip and palate during the first 6 months after childbirth at Srinagarind Hospital, Khon Kaen Province, Thailand. J Med Assoc Thai 2010; 93. Suppl 4; S71-77