Cleft palate and cleft lip are common birth conditions that occur when facial structures don’t fully develop while the baby is in utero.
According to estimates by the Indian Council of Medical Research, every year, about 35,000 children in India are born with either or both of these conditions.
A cleft lip can be seen when the upper lip is split; a cleft palate will show as a gap in the roof of the mouth. If they are not corrected, these conditions may also lead to speech, dental and hearing problems. However, with surgery, babies born with these conditions are able to have full function of their mouths and typically avoid all of these related issues.
However, these surgeries can’t be performed until 3 to 6 months in the case of cleft lip, and 6 to 12 months in the case of cleft palate. In the meantime, these conditions can cause difficulty breastfeeding.
What causes cleft lip and/or palate?
The exact cause of cleft palate and lip still remains unknown, but these conditions are thought to be influenced both by genetic factors, as well as lifestyle factors, including smoking and consumption of alcohol during pregnancy, obesity and a lack of folic acid intake during pregnancy.
A typical ultrasound doesn’t spot a cleft lip or palate. While sonography between 18 and 22 weeks of gestation can occasionally pick up the condition, it doesn’t always. However, if the scans gave no indication of your baby’s cleft lip or palate, there the conditions will be detected immediately after birth or during check ups in the 72 hours after.
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Breastfeeding a baby with a cleft lip and/or palate
Babies born with a cleft lip are able to breastfeed normally. So are babies born with a cleft palate; because nipples are soft, there is no risk of damage to the palate.
But with a cleft palate, it is possible that breast milk may come out of the baby’s nose while feeding. That’s because the barrier between the mouth and nose may be missing. With cleft palates, babies also have difficulty creating enough suction to stimulate let down. This can reduce your ability to express an optimal volume of breast milk, putting the baby at risk of not getting enough nutrients for proper growth.
When it comes to breastfeeding a baby with a cleft palate, any amount of time spent at the breast is good. You can ensure the baby’s latch is sealed by holding your breast in the baby’s mouth and pressing the breast with the index and middle finger on either side of the nipple, thereby making the breast protrude as if full of milk. It will make feeding for the baby easier when there is no grip available naturally. And in order to deliver maximum milk, practice breast compression, that is, gentle squeezing of the breast as the baby feeds.
For babies with cleft palate, cleft lip or both, various feeding positions are advised, unique to each baby and their condition. Pediatricians and lactation consultants will be able to determine the best one for your baby. Special bottles, depending on the baby’s specific type of palate and lip deformation, can also be used to feed. You could also consider using feeding options such as cup feeding, spoon feeding, or syringe feeding, if breastfeeding proves too difficult.
However, in these scenarios, if you are committed to providing breast milk, you will need to express milk regularly by pumping in order to keep the supply optimal.
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Surgery for cleft lip and cleft palate
Surgery for cleft lip generally lasts one to two hours and is performed on babies when they are 3 to 6 months old. The procedure involves general anesthesia followed by closing the cleft lip with stitches. It may require a hospital stay for a day or two, while the stitches either dissolve or are removed by a doctor, depending on the kind used. The surgery will leave a slight scar, but the surgeon will attempt to line up the scars with the natural line of the lip to make it less noticeable. It will fade over time.
For a palate surgery, the baby needs to be between 6 and 12 months old. This surgery also takes one to two hours, and also requires general anesthesia. Surgeons will close the roof of the mouth and rearrange the lining of the palate. Unlike the scar from a cleft lip surgery, the palate repair scar is inside the mouth and not visible.
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Breastfeeding after a cleft lip or palate surgery
Breastfeeding after surgery is not only possible, it’s advantageous: breast milk enhances a baby’s immunity, helping to protect against any post-op infection. It will also help their teeth and jawlines better develop as they are healing.
It even possible to breastfeed immediately after surgery. Once the cleft is corrected, the baby will find it much easier to feed. While there may be some initial hitches, as the baby learns to breastfeed in a new way, they will not last long.
