No suction — but baby can swallow
The key message
Babies with cleft lip and palate can swallow — their swallowing reflex is intact. What is missing is the negative pressure in the mouth needed for normal sucking. Specialist bottles can fully bridge this problem.
With a complete cleft palate, an opening connects the mouth and nasal cavity, making it impossible to create the seal needed for suction. The baby works hard but takes in too little milk and tires quickly.
The solution: specialist bottles with a valve system or soft teat that deliver milk actively or with very little pressure.
When does my child need a palatal plate – and when not?
The key message
Not every child with a cleft needs a palatal plate. The decision is made by the orthodontic team at the specialist centre, ideally within the first days of life.
Palatal plate needed: complete cleft lip and palate and isolated cleft palate where the baby cannot build sufficient suction. The plate is fitted in the first days at the maternity unit.
No palatal plate needed: isolated cleft lip or cleft lip and alveolus (without palate involvement). These children can still close the oral cavity sufficiently and usually feed well – with or without a specialist bottle.
Grinding adjustments – how it works
The palatal plate is actively adjusted every 4–6 weeks on the inner (nasal) side. This controlled pressure causes the cleft to narrow considerably over the first months of life, facilitating the later operation. The plate is worn until closure of the soft palate at the latest.
In cases of Pierre Robin Sequence or additional problems, adaptation to the plate takes longer and requires closer follow-up by the specialist team.
The three main systems
There are three well-established systems. The best choice depends on the cleft type and the individual baby. The specialist centre will demonstrate all three at your first appointment.
Medela SpecialNeeds Feeder
Also known as the Haberman Feeder. A valve in the teat releases milk with gentle tongue and jaw pressure — no suction required. Works for all cleft types, including severe ones. Available from pharmacies and Medela retailers.
Pigeon Cleft Palate Feeder
An angled teat with a soft side and a firm side. The soft side is placed over the cleft. Milk flows with gentle external pressure on the bottle. Well suited for isolated cleft lip or smaller clefts.
NUK cleft teat
A specially shaped soft teat for standard bottles. Easy to obtain. For milder cleft forms or as a transition after lip repair when the baby begins building suction.
Practical feeding tips
Keep baby as upright as possible (45–90°) to reduce milk entering the nose. Keep feeds to 30–40 minutes — longer sessions burn more calories than the baby gains. Allow regular burping breaks.
Breast milk is possible — direct nursing usually is not
With a complete cleft palate, direct breastfeeding is usually not possible as the baby cannot generate suction. With an isolated cleft lip, it is sometimes achievable with an adapted position.
Pumping is a fully valid option
Breast milk can be expressed and given through the specialist bottle. Regular pumping is recommended (8–10 times daily in the first weeks). A lactation consultant can support you.
- Contact a lactation consultant as early as possible (ideally in the maternity unit)
- Rent a double electric breast pump (covered by insurance with prescription)
- Expressed milk keeps for up to 5 days refrigerated
- Supplementing with formula is safe if supply is insufficient
Weigh regularly — act early
| Phase | Target | Assessment |
|---|---|---|
| Weeks 1–2 | Regain birth weight | normal |
| From week 3 | ≥ 150–200 g per week | good |
| Before lip repair | Target ~5 kg, good general condition | ready for surgery |
| Warning sign | < 100 g/week over 2 weeks | Contact specialist centre |
When to contact us immediately
If weight gain is less than 100 g/week, feeds take more than 40 minutes, baby turns blue during feeding, or milk comes out of the nose — please contact your specialist centre or paediatrician without delay.
Questions about feeding?
We are happy to help by phone or email.