Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients Caregivers Providers
Log In Ask a Question
PubMed This is a summary of 7 peer-reviewed journal articles Updated
Pediatrics · Cleft Lip and Palate

The First Few Months: Feeding and Early Care

At a Glance

Babies with a cleft palate cannot create suction and require specialized bottles that use compression for feeding. Feedings should be done upright, last no more than 30 minutes to conserve the baby's energy, and weight gain should be closely monitored by a pediatrician.

Feeding is often the first and most stressful challenge parents face after a cleft diagnosis. It is completely normal to feel a sense of panic or frustration when traditional feeding doesn’t go as expected.

The Mechanics of Suction

To pull milk from a breast or a standard bottle, a baby must create a vacuum (negative pressure) by sealing their mouth and using their tongue and palate. When there is a cleft in the palate, air leaks through the gap into the nose, preventing that vacuum from forming—much like trying to drink through a straw with a hole in the side [1].

Important Note: Babies born with an isolated cleft lip (where the palate is fully intact) can often breastfeed normally because they can still create suction. However, if the palate is involved, suction is mechanically disrupted [1]. This is a physical issue, not a failure on your part.

The First 48 Hours: A Checklist

To help channel early panic into productive steps, focus on these immediate priorities:

  1. Secure Specialized Bottles: Work with the hospital’s feeding specialist to get the correct bottle system.
  2. Establish Pumping (If Desired): If you plan to provide breast milk, start a rigorous pumping schedule to build your supply.
  3. Schedule a Weight Check: Book an appointment with your pediatrician for 2–3 days after discharge to monitor weight gain.
  4. Contact an ACPA Team: Reach out to the nearest accredited multidisciplinary team to schedule your initial consultation.

Specialized Feeding Systems

Because babies with a cleft palate cannot “suck,” specialized bottles are designed to work through compression (squeezing) rather than suction.

  • Dr. Brown’s Specialty Feeding System: Uses a one-way valve that keeps the nipple full of milk. The baby only needs to compress the nipple with their tongue and gums [1].
  • SpecialNeeds Feeder (formerly Haberman): Allows the caregiver to assist by gently squeezing the nipple in rhythm with the baby’s swallow [1].
  • Pigeon Nipple: A firmer nipple with a thick side (to be placed against the roof of the mouth) and a thin side (for the tongue to compress) [1].

Upright Feeding and Daily Hygiene

  • Upright Feeding: Always feed your baby in an upright or semi-upright position. Because the palate is open, feeding them lying down allows milk to flow directly into the nasal cavity and the Eustachian tubes, leading to choking, discomfort, and ear infections [1].
  • Nasal Regurgitation and Hygiene: It is extremely common for milk to come out of the baby’s nose during feeding. Keep a cloth handy to gently wipe the nose. After feedings, you may use a gentle saline drop or a damp cloth to clean the nasal passages and prevent the milk from crusting, which can irritate the skin.

Monitoring Growth and Weight Gain

Infants with clefts use more energy during feeding and may gain weight more slowly at first [2].

  • The 30-Minute Rule: Feedings should ideally last no longer than 30 minutes. If it takes longer, the baby may burn more calories through the effort of eating than they are consuming.
  • Fortification: If weight gain is a struggle, your team may suggest “fortifying” breast milk or formula. Never do this without a doctor’s specific recipe.

Pierre Robin Sequence (PRS) and Safe Sleep

Some babies with a cleft palate also have a very small lower jaw (micrognathia) and a tongue that sits further back in the throat (glossoptosis) [3]. This combination is called Pierre Robin Sequence (PRS). The tongue can block the airway, making breathing difficult when lying flat [4].

For PRS, doctors may prescribe “prone positioning” (lying the baby on their stomach or side) to keep the airway open [5]. WARNING: You must never place an infant on their stomach to sleep unless explicitly prescribed and closely monitored by your medical team, as this directly contradicts universal SIDS prevention guidelines.

Preparing for Surgery: Orthopedics

Before the first surgery, your team might suggest presurgical orthopedics:

  • Nasoalveolar Molding (NAM): A custom-made plastic plate worn in the mouth to gently guide the gum segments together and shape the nose [6].
  • Lip Taping: Specialized medical tape used to gently pull the sides of the lip closer together [7].

Common questions in this guide

Why can't my baby breastfeed normally with a cleft palate?
A cleft in the palate prevents your baby from creating the necessary vacuum to pull milk from a breast or standard bottle. It is a physical, mechanical issue where air leaks through the gap into the nose, disrupting suction. Babies with an isolated cleft lip, however, can often breastfeed normally.
Which specialized bottles are best for babies with a cleft palate?
Because babies with a cleft palate cannot suck, they need bottles that work through compression instead. Common options recommended by feeding specialists include Dr. Brown's Specialty Feeding System, the SpecialNeeds Feeder, and the Pigeon Nipple.
Why does milk come out of my baby's nose during feeding?
Because the palate is open, milk can easily flow upward into the nasal cavity during a feeding. Feeding your baby in an upright position helps minimize this issue. You can use a damp cloth or saline drops to gently clean the nasal passages after feeding.
How long should a feeding take for a baby with a cleft?
Feedings should ideally last no longer than 30 minutes. Infants with clefts use more energy during feeding, and if it takes longer, your baby may burn more calories through the effort of eating than they are actually taking in.
What is Pierre Robin Sequence (PRS)?
Pierre Robin Sequence is a condition where a baby has a cleft palate, a very small lower jaw, and a tongue that sits further back in the throat. This combination can block the airway and make breathing difficult, requiring specialized sleep positions prescribed by your doctor.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How much weight should my baby be gaining each day, and how often should we come in for weight checks?
  2. 2.Based on my baby's specific cleft, which feeding system (Dr. Brown's, SpecialNeeds, or Pigeon) do you recommend we try first?
  3. 3.Does my baby show any signs of Pierre Robin Sequence, and do we need to take special precautions with how they sleep or eat?
  4. 4.Is my baby a candidate for nasoalveolar molding (NAM) or lip taping, and what would that schedule look like for our family?
  5. 5.How long should a typical feeding take before we should be concerned that the baby is burning too many calories?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (7)
  1. 1

    A Successful Nasal Support Device for a 4-Month-Old Baby With Unilateral Cleft Lip and Palate: A Case Report.

    Singh I, Tamchos R, Kapur A, Parashar A

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2025; 10556656251367255 doi:10.1177/10556656251367255.

    PMID: 40853345
  2. 2

    Growth Parameters in Children with Non-syndromic Cleft Lip and Palate versus Healthy Controls: A Cohort Study from Riyadh, Saudi Arabia.

    Alkhattabi F, Aljohar A, Alharbi A, et al.

    Saudi journal of medicine & medical sciences 2025; (13(2)):142-148 doi:10.4103/sjmms.sjmms_253_24.

    PMID: 40352338
  3. 3

    [How I treat : airway obstruction in children with sequence of Pierre Robin].

    Thimmesch M, Seret N, Hens G, et al.

    Revue medicale de Liege 2019; (74(3)):120-124.

    PMID: 30897309
  4. 4

    Prenatal Features Predictive of Robin Sequence Identified by Fetal Magnetic Resonance Imaging.

    Rogers-Vizena CR, Mulliken JB, Daniels KM, Estroff JA

    Plastic and reconstructive surgery 2016; (137(6)):999e-1006e doi:10.1097/PRS.0000000000002193.

    PMID: 27219269
  5. 5

    Flexible feeding obturator for early intervention in infants with Pierre Robin sequence.

    Jadhav R, Nelogi S, Rayannavar S, Patil R

    The Journal of prosthetic dentistry 2017; (118(6)):778-782 doi:10.1016/j.prosdent.2017.01.012.

    PMID: 28449865
  6. 6

    Presurgical nasoalveolar molding with 3D printing for a patient with unilateral cleft lip, alveolus, and palate.

    Zheng J, He H, Kuang W, Yuan W

    American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2019; (156(3)):412-419 doi:10.1016/j.ajodo.2018.04.031.

    PMID: 31474271
  7. 7

    The Effect of DynaCleft® on Cleft Width in Unilateral Cleft Lip and Palate Patients.

    Vinson L

    The Journal of clinical pediatric dentistry 2017; (41(6)):442-445 doi:10.17796/1053-4628-41.6.4.

    PMID: 28937909

This page provides informational guidance on feeding and early care for infants with a cleft lip or palate. Always consult your pediatrician or cleft team for personalized medical and feeding advice.

Get notified when new evidence is published on Cleft lip/palate.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.