Feeding a Baby with a Cleft Lip and/or Cleft Palate

Cleft lip and/or palate

If your baby is born with a cleft lip or palate, you may be told that breastfeeding is not going to be possible. Depending on the position and severity of the cleft you may discover that you can breastfeed. However, it may look different than imagined. An IBCLC (International Board Certified Lactation Consultant) can help you create a breastfeeding plan. It may take time for you and your baby to figure out if breastfeeding will be possible. Feeding your baby your expressed milk is always an option while you are learning to feed at the breast. Or you may continue to feed your baby your expressed milk long-term if feeding at the breast is not possible, or if that is your preference.

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. They occur in the womb when your unborn baby is developing. They are among the most common birth defects and will be surgically repaired when your baby is old enough for the surgery.


Cleft Lip

The opening in your baby’s lip can make it difficult to achieve a good seal. This gap in the lips allows air to escape. Without a good seal, your baby will have difficulty getting enough milk. If you hear a hissing sound when the baby is breastfeeding, reposition your baby so your breast fills the gap. You may need to try different positions until you find one that works well. You can also try filling the gap with your thumb.


Cleft palate

A cleft palate occurs when your baby’s palate does not close while still in your womb. The hard palate (bone) is the front part of the roof of your baby’s mouth. The soft palate (soft muscle) is the back part of your baby’s mouth. A cleft can be of the soft palate or both the soft and hard palates. It can occur on one side of your baby’s mouth or both sides. Another type of cleft is called a ‘submucosal cleft’. This is when there is an opening of muscle or bone that is hidden by intact skin. This type of cleft may not be visible and is often not detected until babies are several days old.

Whether or not your baby will be able to feed directly from the breast will depend on the severity and placement of the cleft. The cleft may prevent your baby from forming a complete seal. Or it may prevent your baby from compressing the breast effectively. If the cleft is small your baby may be able to plug the hole with your breast tissue while she is latched. This will allow her to get the suction required to hold your nipple in place while nursing. It also depends where the cleft is in your baby’s mouth. If the cleft is only on one side your baby may be able to compress the breast effectively enough on the other side to mechanically remove milk, even though she cannot make a good seal. Then she may be more likely to be able to at least partially breastfeed.

Positioning suggestions
A cleft in your baby’s mouth can cause milk to flow back into your baby’s nasal cavity and airway no matter how they are fed. If you are breastfeeding it is important to find a breastfeeding position that will help to prevent this from happening. See Positioning and Latching.



Laid-back position:
Use the slightly more upright version of the ‘laid-back position’ with your body at a 55 to 65 degree angle. Place your baby on top of your body at an angle. This will allow gravity to help keep your baby deeply onto the breast. This can help him form a proper seal. It can also help prevent milk from entering his nasal cavity and airway.


Sitting upright

Sitting upright position: Another position you may find helpful is to have your baby sit upright with his legs straddling your leg. Offer your baby the same breast as the leg he is sitting on.


Breast support
Breast support:
You may need to support your breast while your baby is latched to help her keep the breast deep in her mouth while feeding.


Dancer hold
Dancer Hold:
If your baby requires extra help, the Dancer hold can allow you to support her jaw and cheeks to help her stay on the breast.


Assisting your baby
It is important that your baby’s tongue is able to compress the breast in order to remove milk effectively. If this is not possible, your baby may need help getting your milk. Or you may need to feed your baby your milk another way.
Breast compressions: Doing breast compressions throughout the feeding can help your baby remove the milk.
At-breast supplementer: You may want to try a nursing supplementer at the breast with your own milk, while feeding. This will allow your baby to drink some milk directly from your breast while also getting your expressed milk at the same time. At-breast supplementers usually require suction to remove the milk. You may need to hold the container of milk up high. This allows gravity to help the milk flow into your baby’s mouth.
Syringe feeding at breast: You can attach a syringe to the end of the feeding tube to supplement at breast. Insert the tube into your baby’s mouth while he is at breast. Gently press the syringe as your baby sucks.
Milk expression: If your baby is not able to breastfeed, you will need to express your milk by hand or pump. Pump or hand express frequently. This is usually eight or more times in 24 hours. Frequent milk removal tells your body to maintain reliable milk production. You can feed it to your baby another way, until your baby is able to undergo surgery to repair the cleft.
Bottle feeding: Use your expressed milk to exclusively human milk feed your baby. Babies with a cleft palate often need a special bottle to feed. Babies fed by bottle can still be comforted regularly at the breast. They can do some drinking at the breast or snuggle skin to skin.

Breastfeeding After Surgical Repair
In Canada, repair surgery for a cleft lip is usually done when a baby is between three and six months old. Cleft palate repair surgery is usually done when a baby is between six months and one year old.

Surgical Repairs

Plans for breastfeeding:

  • Discuss with the surgeon how soon you can breastfeed after surgery.
  • Until breastfeeding is possible, your expressed milk can be fed to your baby.
  • Hold your baby and feed your baby near your breast. Learning to feed at the breast may take time and may be easier if your baby is familiar with being held and comforted at the breast during the waiting months.

Ask for help from an IBCLC to establish a deep latch and effective suck.

If you need support or suggestions for breastfeeding or exclusive pumping for your baby with a cleft lip or palate, please contact your local La Leche League Canada Leader.

If you have found this information helpful, please consider making a donation to LLLC.

Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc., pages 283-291.

Academy of Breastfeeding Medicine

CLAPA Cleft Lip and Palate Association

Canadian Association of Oral and Maxillofacial Surgeons