Can You Breastfeed A Baby with Cleft Palate? My Experience

When I first found out that one of my twins had cleft palate, whether or not I could breastfeed was one of the first questions I had. However, my story is pretty unique and usual. I’ll share it with you along with the most up-to-date recommendations. I want you to be able to navigate feeding your precious cleft baby armed with the right resources. 

Disclaimer: This post does not constitute medical advice. I am simply sharing my experience and providing informational resources. 

Breastfeeding a Baby with Cleft Palate: Is It Possible?

Is it actually possible to breastfeed a baby with cleft palate? 

I want to start this post with encouragement and let you know from the start that it is possible. However, it’s not easy, it’s not straightforward, and it’s not sustainable as the only source of nutrition for your baby. 

Why Babies with Cleft Palate Have Difficulty Breastfeeding 

The main reason babies with cleft palate have difficulty breastfeeding is that they can’t create proper suction. I’ve witnessed this firsthand, without even knowing that my baby had cleft palate (more on this in the next section). 

To create the suction necessary to hold the breast and pull the nipple in, babies need to get a good latch and sustain it. To do this, babies will intuitively lift the soft palate up and back once they take the nipple in, which seals the back of their mouth. As the tongue and jaw drop during sucking, suction is generated, drawing milk from the breast.

Babies with cleft palate usually can’t do this. Think of the cleft, in simplistic terms, as a hole. Now, try to create suction in your mouth. You can feel pressure being created right at the back of your mouth, where your baby has a cleft. Their cleft makes air (and food!) go through, instead of being held back. 

This means that babies with a cleft palate may try to create suction, but it’s very weak and temporary. It’s almost like trying to completely suck the air out of a balloon with a hole in it. You can never get that “no air,” suction feel.  

If your baby has both soft and hard cleft palate, this may be even trickier. Even temporary suction can feel draining and difficult. 

How the Type of Cleft Affects Breastfeeding 

Cleft Lip Only

Babies with cleft lip only don’t have a problem creating suction, although they may find it more challenging to create a proper latch. However, once they latch, they can usually create suction to breastfeed if their palate is unaffected (Reilly et al., 2013). 

Soft Palate Only

If your baby has a small cleft of the soft palate only, they may be able to generate some suction. In some cases, this suction may be enough to support breastfeeding, especially when combined with certain techniques and positions! (Reilly et al., 2013)

When it comes to cleft palate only, the Academy of Breastfeeding Medicine (ABM) states that there’s no strong evidence that babies with cleft palate can breastfeed. There was moderate evidence that babies with cleft palate don’t create suction when bottle feeding. They state that although babies with clefts of the soft palate may be able to create suction, this is not usually the case (Reilly et al., 2013). 

Studies indicate that breastfeeding success for babies with cleft palate is much lower than for infants with cleft lip. Yet, it’s encouraging that there was weak evidence to suggest that babies with cleft palate can achieve partial breastfeeding, although they require supplementary bottle feeding. The main factors determining whether a baby with cleft palate may be able to partially breastfeed are the size and location of the cleft. Again, modifying breastfeeding positions can increase the chance of success (Reilly et al., 2013). 

Cleft Lip and Palate

According to clinical guidelines published by ABM, there is no strong evidence that babies with cleft lip and palate can successfully breastfeed or create suction using a bottle. But, there’s also moderate to weak evidence that babies with cleft lip and palate are sometimes able to breastfeed successfully  (Reilly et al., 2013). 

Studies suggest breastfeeding success rates ranging from 0% to 40%. They point out that modifications to positioning can increase breastfeeding success and should be recommended by experts (Reilly et al., 2013). 

Prematurity 

Another big factor is whether your baby is premature or not. Newborns and premature babies can create less suction than older babies. Cleft palate babies, in most cases, won’t be able to create proper suction even if they’re not premature. But prematurity plus cleft palate can make it even more difficult (Reilly et al., 2013). 

Academy of Breastfeeding Medicine Recommendations for Babies with Cleft Palate

Education and Support

According to the Academy of Breastfeeding Medicine (ABM), all mothers should be encouraged to provide the protective benefits of breastmilk to their babies. At the same time, mothers should be counseled about likely breastfeeding success. This means understanding that exclusive breastfeeding is unlikely, but breastfeeding for bonding and stimulating milk flow is absolutely beneficial, as is pumping breastmilk (Reilly et al., 2013). 

However, many providers are not educated enough to provide support to women with cleft palate babies who want to breastfeed. In turn, most women aren’t told that they can even try breastfeeding their baby and experiment with different positions and techniques. Plus, women who have managed to breastfeed their cleft palate babies might not be part of the statistic we’re looking at. All in all, there’s a lot of room for additional support, research, and education!

ABM also outlines that each baby with cleft palate should be individually evaluated for breastfeeding, taking into account the size and location of their cleft and the mother’s wishes and previous experience with breastfeeding. This is key! (Reilly et al., 2013)

ABM states that, as with breastfeeding in general, knowledgeable support is critical. They state that: “Mothers who wish to breastfeed should be given immediate access to a lactation specialist to assist with positioning, management of milk supply, and expressing milk for supplemental feeds.”

If your baby has cleft palate (or you’re expecting a baby with cleft palate), don’t let this discourage you! If you want to breastfeed your cleft baby alongside pumping and bottlefeeding, this is absolutely doable. 

Juggling Expectations 

While it’s important to get all the education and support you can, try to avoid putting unreasonable expectations on yourself and your baby. You will both be doing the best you can. Be open to finding the best feeding solutions with this in mind and try not to cling to what you “must” do. 

For example, you may be set on breastfeeding your cleft baby alongside supplementary bottle feeds for at least six months, but you manage to do it for only two months. This is still fantastic! On the other hand, you may expect challenges and be happy even if you manage to provide your baby breastmilk over the first few weeks after birth, but end up being able to breastfeed and pump for much longer. 

Remember that the act of breastfeeding is super hard for your cleft palate baby. Unlike babies that don’t have cleft palate, it’s hard work for them. They may keep trying to create suction on your breast (or attempting to feed with a regular bottle), but they simply can’t anatomically sustain it. This can make them very tired, cause sores and blisters, and make feeding really long and draining. 

Breastfeeding a baby with cleft palate is also challenging for the mother. Arm yourself with patience and knowledge. It may feel frustrating at times because your baby can’t achieve a typical latch. Sometimes it may feel impossible, no matter what position you try. Feeding will take more time, as both you and your baby put in all the energy you have to make it happen. 

When you feel too tired and overwhelmed, it’s ok to take a break. Let yourself and your baby rest, give your baby supplemental breast milk or formula, and try again once you both feel up to it. 

If you manage to breastfeed even a bit, fantastic job! I can count the number of times my cleft baby latched on my fingers, but I was so proud of us. That feeling of your baby latching and getting a bit of your breastmilk, even for a short moment, is beyond words and well worth it. 

Yet, I also learned to have no shame around giving my baby supplemental feeds. Even bottle feeding can be tricky, and mastering it is another craft. Your baby is likely to experience milk going up his or her nose and swallowing air along with milk, sometimes causing fussiness and gas. You’ll need to use a special bottle or adapt your bottle to your baby (by creating an X cut in the bottle hole to help more milk flow out). Your cleft baby is a little warrior, and the most important thing is that they’re growing and thriving along with you. 

Although your baby probably won’t be able to exclusively breastfeed, even a tiny interval of breastfeeding carries many emotional and nutritional benefits for your baby. We’ll go into the techniques and considerations in the third section. But first, let me share my story and experience with you. 

My Story & Experience 

Struggling After Birth 

My third pregnancy was a twin pregnancy filled with many unexpected twists and turns. At 37 weeks, I had a great homebirth and gave birth to a boy and a girl: Vojin (boy) and Visnja (girl).

Once both babies were born and I was settled, I tried placing them both at the breast. They were small and quite skinny (2.3 kg each), but vigorous. Vojin latched, but Visnja just put her small lips to one of my breasts for a moment… and that was it. It was almost like she was softly kissing the nipple. I was so confused and worried, because I was under the impression that she didn’t even try to latch. I couldn’t figure out why and what was wrong. 

The first months were difficult and overwhelming. Reflecting back on it, I knew I needed to be strong and give it my all, but I was also drained and depleted. Since my babies were twins and had a smaller than average weight, I was so focused on them and their feeding to make sure they were gaining weight. I was constantly checking up on them and observing them, with a dose of worry I didn’t have with my first two singletons. 

My midwife also briefly examined the twins when they were born, but she wasn’t trained to check for clefts. I took them to a pediatrician soon after birth, who checked them, and everything seemed fine. Yet, I would only learn that my girl Visnja had cleft palate two and a half months later!

In the meantime, I even took her to a pediatric oral surgeon, suspecting a tongue tie. She didn’t see the cleft either, which is quite a shocker looking back. I hired a lactation consultant, and we even did craniosacral therapy. Not surprisingly, none of this made a major difference. 

Signs We Didn’t Understand 

I was being told by various people I consulted that there may be emotional reasons Visnja is not latching, or that it may have something to do with her positioning in the womb (she was born breech). Yet, none of it made sense to me. I had this feeling that something was anatomically preventing her from latching and breastfeeding, but I didn’t know what. 

My husband and I would notice the cleft in her palate when she cried, but we just thought that’s what her “throat” is like. She would get milk coming up her nose after feeds, but we thought it was just because she was swallowing air and having trouble with reflux. She would take forever to feed with a regular bottle, so I fed her with a syringe additionally. I was pumping milk and collecting my milk with a Hakka every time her brother Vojin breastfed. 

I additionally struggled in the first week postpartum, as I had so little colostrum (something I experienced with my first as well). I did everything. Manual expression, stimulation, feeding as often as possible, teas, food, rest—I did it all. Luckily, I managed to get my supply up once my milk was established and exclusively breastfed the boy for over a year. 

Lacking guidance and not finding any answers, I still didn’t give up on figuring out why my girl wasn’t breastfeeding and why she was struggling so much. Sometimes, in the morning, I would notice blisters on her mouth as she struggled to feed with the regular bottle. My heart breaks to think about it now, also reflecting all the signs that were there, but lacking proper professional assessment to get clarity on what was causing it. 

Still, in a way, I am grateful for the way things played out because I actually managed to partially breastfeed her. Perhaps I would’ve given up earlier if I was told about her cleft by someone not knowledgable or supportive of breastfeeding. 

Breastfeeding

When attempting to breastfeed, I couldn’t do anything “just” offering her my breast. So, I figured out a technique (I wish I could find the picture and attach it here!). I got a breastfeeding pillow, and would place each twin in a football position, one to each of my arms. Then I’d first latch the boy to get my milk flowing. Then I’d put on a nipple shield and get my girl to hold onto it as the milk passively flowed. This worked pretty well. 

I would also try to breastfeed her alone with the nipple shield. It was more difficult to get a letdown, but sometimes it worked. The nipple shield helped as it was firm and I could place it in her mouth, sort of like a bottle. I also have quite small nipples, and she couldn’t even keep my nipple in her mouth without the shield. Perhaps women with bigger nipples may find it easier to get their cleft baby partially latched. 

And so, we did this for months: breastfeeding as much as possible with the shield + pumping + supplemental formula with a bottle and syringe. Repeat. Nights were the hardest, and sometimes I would just breastfeed Vojin at night while giving Visnja the bottle. 

Hospital Stay and Getting a Diagnosis

Then, at 2.5 months old, shortly before New Year’s, both twins got a respiratory infection. As I noticed that it wasn’t getting better with the typical at-home measures after a couple of days, I started to worry. 

It was December 31st, and the night before, nobody slept well. Both twins were coughing and waking up. During the day, I noticed that my girl was having trouble breathing. We rushed to the ER, and it turned out they both had RSV and bronchiolitis. We were admitted to the hospital, and that was one of the hardest New Year’s of my life. 

Luckily, they both started stabilizing after 4-5 days. At discharge, we were sent for an exam by the ears, eyes, and nose (ENT) doctor. When the doctor examined Visnja, she looked at me and said nonchalantly: “She has a cleft of the soft palate.” 

It’s as if everything unravelled before my eyes. But I just stood there, staring, and said, “She does?” Part question, part acknowledgment.  

I walked out both in shock, gratitude, and resolution. It was through this difficult hospital experience and health complication that I finally got the answer I’d been searching for. 

So, I could finally educate myself. I started reading about clefts and understanding cleft palate. I read all about the best ways to feed and support her, and I started thinking about surgery and the next steps. 

Next Steps and Surgery 

The first thing I did was to modify the bottle we were using. I took clean, sterile scissors and cut an X on the tip of the bottle’s nipple. This helped LOTS. She was finally gulping down milk without struggling. We kept up occasional breastfeeding for 6 months, and she was 90% on my expressed breast milk during this time. I’m so proud of this, but it was also hard and demanding.

After 6 months, we started some solids, and I was gradually expressing less and adding on more formula. At about 8 months, we were at 90% formula and 10% my breast milk. Shortly after, I stopped expressing and only kept breastfeeding her brother. My supply was lower at this point, but I was satisfied with our journey. We made it a long way. 

At 17 months, she had her cleft palate surgery. Initially, I was researching when is the earliest she can have surgery so that I can breastfeed her after. However, she was smaller, and although she was gaining weight nicely, she was barely 9 kg at one year old. We decided to wait until 17 months when she was a lot stronger, had a bit over 10 kg, and was healthy. It turned out to be perfect timing, and despite my being super nervous and worried, she recovered from the surgery like a champ. 

While I was researching ways to breastfeed her before surgery, I came across this post by UK-based lactation consultant Anna, whose son also had cleft palate. I got in touch with her and she was so helpful and supportive, sharing her experience with her son Oscar, and giving me tips about breastfeeding positions I can try. Oscar had early cleft palate surgery at 6 months, so she was able to breastfeed him after. Another fantastic and encouraging story!

Reflections and Realizations

Fast forward to today, Visnja is a thriving almost two-year-old. She loves food, she’s drinking fluids like a pro, and is doing amazing overall. 

Prior breastfeeding experience and the fact that Visnja’s twin Vojin was breastfeeding helped lots. It would’ve been much harder to pump only and keep up my supply that way, especially since I seem to be prone to low supply. But the biggest turning point was getting a proper diagnosis and finding the right resources and support. 

This also made me reflect on my views about birth, postpartum, and mothering in general. Initially coming from a freebirth perspective, I realized that I had become too rigid in the way I view medical systems and treatments. Since, I’ve really opened up and expanded to a much broader outlook. 

I’ve come to realize that, yes, there is a place for medical intervention. I’ve experienced it firsthand with Visnja. I’m grateful for the amazing doctor and surgeon who performed her surgery, who also turned out to be a genuinely kind and caring human being. My whole experience had reverberations in my life and the way I support women. 

I have come to understand nuance and individual complexity in a deeper and much more personal way. Now, I can truly say from the bottom of my heart that there is no right or wrong way to do things. There is only your way, and may you be supported and informed enough to discern it. 

My journey was anything but typical, but I’ve learned so much along the way. And I hope my experience helps other women who have a desire to breastfeed their cleft babies. 

Cleft Palate Breastfeeding Positions

Finding a breastfeeding position that enables you to get your nipple as deep into your cleft baby’s mouth is key. This is because your baby can’t properly suck your nipple in and hold it, so you may have to hold your breast throughout the breastfeeding session. 

Here are some positioning recommendations, based on both the ABM recommendations, my experience, and the advice I got from Anna:

1. Semi-upright Positions

Keep your baby semi-upright to reduce the amount of milk going up into the nose and ears.

Breastfeeding lying down is not optimal for babies with cleft palate, both because it’s harder to get a deep partial latch and because it can cause more breast milk to enter the nose and ears, causing discomfort and possibly even long-term ear problems. 

2. Football hold/twin position

This often works better than the more common cross-cradle position. It can help get your breast and nipple deeper into your baby’s mouth while holding your breast.

3. “Shaping” your breast

Try “shaping” your breast with your hand before feeding, so that you form it into a sort of “pancake” (who knew I’d use the words “breast” and “pancake” in the same sentence?). 

This may help you place more of your breast and nipple into your baby’s mouth. 

If the cleft is large, it may help to tip your breast downward to stop the nipple from being pushed directly into the cleft. This is more relevant for babies who have both hard and soft cleft palate. 

4. Supporting your baby’s chin and/or your breast

Try supporting your baby’s chin to stabilize their jaw during sucking. Also try supporting your breast so that you keep pointing it to your baby’s mouth. 

Additionally, you can try stimulating your breast while breastfeeding by massaging it from the back toward the nipple. This may help with letdown and make it easier for your baby as you’re “squeezing” and stimulating more breastmilk out. 

5. Positioning for hard cleft palate

For babies with hard cleft palate: position the breast toward the side of the palate that has the most intact bone. This may help with compression and stop the nipple from being pushed into the cleft. 

6. Try stimulating your breasts before feeding

Sometimes, it may help to stimulate your breasts before feeding. This can encourage letdown. 

7. Try a nipple shield

This is not part of the official recommendations, but it helped me tremendously. I got the simplest nipple shield and it worked. Just make sure you place it correctly so that it’s not falling off. The nipple shield gives your baby a “hard” point of contact, helping to keep your nipple in your baby’s mouth. Women with larger nipples may manage to do this even without a nipple shield, but that wasn’t the case with me. 

8. Try breastfeeding in the tub

If you take baths with your baby, trying to breastfeed in the tub can help, as warm water helps with letdown and milk flow. You’re also both relaxed, so breastfeeding may come easier. 

9. Try giving some supplemental milk before a feeding

If your baby is tired and very hungry, it may be even harder for him or her to try to breastfeed. It may help to give ½ of a feed before breastfeeding so that your baby is not too fussy and has enough energy for the breastfeeding session. 

Also, remember to give your baby a supplemental feed after a breastfeeding session, especially if it was short. You can also wait a bit after the session and then give the supplemental feed. 

10. Consult a lactation consultant 

Getting support from a lactation consultant knowledgeable about cleft palate can be very helpful. Unfortunately, not a lot of lactation consultants have experience with clefts, but if you find someone locally who does—it’s a win-win! 

Experienced nurses and midwives who have supported mothers with cleft babies may also be a valuable addition to your support team. They can help position your baby during a feed and provide practical tips.  

Mixed Breastfeeding + Pumping + Bottle Feeding 

The best solution for most cleft palate babies is a mix of breastfeeding, pumping, and bottle feeding. It’s important to monitor whether your baby is well hydrated and gaining weight, especially while you are starting out. Make sure your baby has enough wet diapers, is pooping often enough, and is gaining enough weight. 

If your baby doesn’t seem to be hydrated and fed enough, increase supplemental feedings with your breast milk or formula. 

Making sure your baby is hydrated and feeding enough

Here are some rough guidelines as to how many wet and dirty diapers usually signal your baby is hydrated and feeding enough:

Newborn (first week)

• Day 1: At least 1 wet and 1 meconium stool (thick, dark green/black).
• Day 2: At least 2 wets, 2 stools.
• Day 3: At least 3 wets, 3 stools. Stools start turning greenish/brown.
• Day 4: At least 4 wets, 3–4 stools. Stools should be softer, green to yellow.
• Day 5 and beyond: ≥6 wet diapers per day (pale yellow urine, not dark), at least 3–4 yellow, seedy stools per day for breastfed babies (formula-fed babies may have fewer, often 1–2/day, but larger).

After the first month:

• Wet diapers: Still about 6+ per day.
• Poop diapers: Frequency can vary more. For breastfed babies: sometimes still 3–4/day, but some healthy babies may poop only every few days or even weeks (as long as the stool is soft). For formula-fed babies: usually at least 1/day.

The first couple of months are usually the trickiest, and it’ll get easier as you get more skilled and your baby gets stronger. 

My baby, Visnja, had a lot of constipation in the first weeks. Her stools were firm and sometimes she wouldn’t poop for 4-5 days. This was also likely because she was struggling to get enough milk, and the formula I was topping her up with might not have been adequate. Still, since she was getting much more breast milk than formula in the first six months, there was a lot more variation—similar to breastfed babies. 

If you’re worried about whether your baby is gaining enough weight, consult a doctor and a nurse knowledgeable about cleft palate to get additional assessment and support. This can help you know you are on the right track, and make changes or get additional referrals if needed. 

Cleft Palate Baby Feeding Bottle 

There are various specialized feeding bottles available for cleft palate babies. 

Some bottles are soft and squeezable, so that you can gently express milk while your baby feeds, which compensates for weak suction.

You can also find various specialized nipples. They’re sometimes called “cleft palate nipples” or “feeding teats.” These may have wider bases for easier latch, one-way valves or slit openings to control flow, and softer, more flexible material to mimic natural sucking. 

I personally found it the easiest to use a regular bottle with a softer silicone teat. You can cut an X opening in the teat’s nipple with scissors. Just a couple of millimeters on each side works well, but you may try with a smaller opening and broaden it based on how your baby feeds. Creating an X opening also acts as a selective valve, so that milk won’t spill much unless your baby is feeding and the bottle is faced down. I also used a glass bottle whenever possible to avoid plastic exposure. 

If you’d prefer to explore specialized bottles, here are some popular options:

• Medela SpecialNeeds Feeder: Designed specifically for cleft palate and other feeding difficulties; allows controlled milk flow and requires minimal suction.
• Pigeon Cleft Palate Bottle: Has a flexible, squeezable design and a slit nipple to aid feeding.
• Dr. Brown’s Specialty Bottles: Some parents find success using slow-flow or specialty nipples designed for weak suckers. However, in my experience, these also work better if you open up the top with an X. 
• Haberman Feeder: Widely recommended by feeding therapists; provides precise control of flow and allows the caregiver to coordinate squeezing with the baby’s sucking rhythm. However, learning how to use it takes time, and it’s also not as widely available. 

The main cons of these bottles are that they tend to be harder to use. There’s a learning curve involved. They’re also more expensive. But they work for some women, and they may be especially helpful if your baby also had cleft lip and/or both soft and hard cleft palate. 

When feeding your baby with a bottle, remember to warm up your milk or formula to room temperature. I’ve made the mistake of not warming up milk enough several times, and my baby usually didn’t want to feed. I warmed up the milk by placing a glass bottle in a pot of warm water. I never used a warmer because I prefer to have as few gadgets as possible, but some women find milk warmers convenient. 

This was trickiest in the winter when we were on the go, so having a thermos can help if you’re planning on feeding your baby several hours after leaving the house. Portable milk warmers are also an option; these can be super handy if you’re willing to invest in one. 

Can You Breastfeed Your Cleft Palate Baby After Surgery?

Yes, you can breastfeed your cleft palate baby after surgery. 

According to the official recommendations, you can start breastfeeding immediately after cleft lip repair and one day after cleft palate repair (without complications to the wound) (Reilly et al., 2013). 

Check with your hospital and care provider for guidance in your baby’s case, and share the latest recommendations with them in case they are not aware of them. In a survey of cleft palate surgeons regarding postoperative care after palatoplasty, two-thirds of surgeons supported mothers in breastfeeding immediately after surgery—an encouraging statistic! (Reilly et al., 2013). 

I was initially set on breastfeeding after cleft palate surgery, but my baby was already 17 months by then. It had been 9 months since she last breastfed by then, and she simply wasn’t interested. I was ok with that. We actually stopped using the bottle (and pacifier) altogether after surgery and switched to using cups and glasses. Visnja was eating well by then, which helped tremendously. So, we didn’t need to worry much on milk/formula intake but were more focused on solids. She ate purees for the first 4 weeks after surgery and then we gradually introduced textured foods after (coinciding with when her sutures resorbed). 

The younger your baby is and the more you keep up breastfeeding (at least occasionally) in the meantime, the more likely you are to have success breastfeeding after surgery. Don’t put too much stress on you or your baby, though. 

Wrap Up

Breastfeeding a baby with cleft palate is possible, but it often requires a combination of patience, creativity, and support. 

Every baby’s situation is unique, and success depends on the type of cleft, your baby’s strength, and your ability to experiment with positions, nipple shields, and specialized bottles. Supplementing with pumped breast milk or formula is common and perfectly okay. 

What matters most is that your baby is fed, thriving, and supported. Don’t forget to also find support for yourself so that you are rested and nourished enough during this challenging time. 

Ultimately, even small moments of breastfeeding are meaningful and can provide both emotional and nutritional benefits for you and your baby. Try to let go of rigid expectations and know that you and your baby have done your best, no matter if and for how long you manage to breastfeed.