Feeding Your Baby: Challenges and Solutions for CLA

Feeding is often the first and most practical challenge parents face after a Cleft Lip and Alveolus (CLA) diagnosis. Because your baby has a gap in the lip and the gumline (alveolus), the mechanics of sucking and swallowing are slightly different than they are for other infants ^[1][2]. However, because the palate (the roof of the mouth) is intact in CLA, many babies are able to feed quite effectively with the right tools and techniques ^[1][3].

Why Feeding Can Be Challenging

To drink effectively, a baby needs to create a “seal” with their lips to produce suction.

• Loss of Suction: The gap in the lip and gumline acts like a small “air leak,” making it harder for the baby to create the vacuum needed to pull milk from a breast or standard nipple ^[2].
• Fatigue: Because they have to work harder to get the same amount of milk, babies with CLA may tire out before they have consumed enough calories ^[2].
• Swallowed Air: The break in the seal can cause the baby to swallow more air during feedings, which can lead to gas, fussiness, or spitting up ^[4].

Feeding Options and Equipment

Every baby is unique, and your cleft team’s feeding specialist will help you find the best method for your child.

Breastfeeding

For babies with an isolated cleft lip or CLA, breastfeeding is often more achievable than for those with a cleft palate ^[1]. The breast tissue can sometimes “fill” the gap in the lip, helping the baby create a better seal. A lactation consultant can help you with positioning to optimize this ^[5].

Specialized Feeding Systems

If your baby is struggling to get enough milk from the breast or a standard bottle, several specialized systems are available:

• Dr. Brown’s Specialty Feeding System: This system uses a one-way valve that allows the baby to get milk using only tongue and gum compression, rather than relying on suction ^[6].
• Haberman Feeder (SpecialNeeds Feeder): This bottle allows the caregiver to assist the baby by gently squeezing the nipple to control the flow of milk, reducing the baby’s effort ^[6][7].

Feeding Tip: Try holding your baby in an upright or semi-upright position during feeding. Even with an intact palate, gravity helps improve milk flow into the stomach and reduces the chance of milk coming back out through the nose due to the compromised lip seal.

Daily Care and Hygiene

After feedings, it is important to keep the cleft and gum area clean. You can gently wipe the area with a soft, damp cloth or a piece of sterile gauze to remove any milk residue. This simple step prevents irritation and keeps the gums healthy before teeth start coming in.

Monitoring Growth and Weight

Babies with orofacial clefts are often tracked very closely to ensure they are meeting their growth milestones. Your pediatrician and cleft team will use standard World Health Organization (WHO) growth charts to monitor weight-for-age and length-for-age ^[8].

It is common for infants with clefts to have slightly slower growth rates initially, but those with CLA typically face fewer growth deficits than those with more complex clefts ^[8][4]. Consistent weight gain is a primary indicator that your feeding strategy is working ^[5].

The Role of Nasoalveolar Molding (NAM)

In the first few weeks of life, your team may recommend Nasoalveolar Molding (NAM) or a Hotz plate ^[5].

• What it is: A custom-made orthopedic appliance (similar to a dental retainer) that the baby wears 24 hours a day ^[9].
• How it helps: It gently guides the gum segments closer together and shapes the nose before the first surgery ^[9][10].
• Feeding benefit: While its primary goal is surgical preparation, some parents find the plate provides a more solid surface for the tongue to press against, occasionally assisting with feeding ^[11][12].

By working closely with your feeding specialist and monitoring your baby’s cues, you can ensure they receive the nutrition they need to grow strong ^[13].