A cleft in the palate means that your baby may have difficulty in sucking effectively as he or she is unable to create a good vacuum inside the mouth, and correctly position the tongue. 

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Not all teams are agreed on the benefits of using feeding and orthopaedic plates from birth so do ask if and why a plate is considered necessary for your baby. 

Some teams use a small feeding plate for the baby to wear in the roof of the mouth. This may be made by your orthodontist to:-

• assist with breast feeding
• protect the delicate tissue in the roof of the mouth 
• keep baby's tongue out of the cleft

A special orthopaedic plate may be used to begin to apply pressure to close and align the cleft prior to surgery. Plates ( obdurators ) need to be checked and adjusted or renewed at intervals so the orthodontist will want to see your baby regularly.  

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Normally when we swallow the palate closes to stop us swallowing air from our nose. Babies with a cleft palates cannot do this so they will swallow air when they feed. If your baby appears windy try the methods suggested earlier in the introduction. 

Milk may pass into the nose and cause sneezing or some milk may come down the nose if your baby is being sick. Your baby will normally clear this but have some tissues or a bib handy ! 

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This is possible and works well when the cleft is small or narrow. The breast needs to be held well into the area where there is palate so that the baby can get a good grip and work at the breast with the tongue.  

If your baby is allowed to practice on the still soft breasts in the early days, it will be easier for you to find a position that is comfortable for both of you and baby will benefit from the valuable colostrum. At about 2 - 4 days after delivery when the breasts fill it will be natural for him or her to have more difficulty in breastfeeding. 

It is helpful to have a good flow of milk, as your baby may not have a strong enough suck to stimulate the flow. The flow of milk can be encouraged by massaging the breast or by using a breast pump. Your midwife will be able to show you how to massage your breast and hand express the milk when a breast pump is not available. 

The breasts need to be expressed after feeding to ensure that they receive adequate stimulation. The baby satisfies his thirst on first suckling and his hunger on the hind milk which contains more calories. Your baby may need to be supplemented using expressed breastmilk with an alternative feeding method as his suckling may not give him sufficient volumes of milk to ensure adequate growth.  

If your baby is unable to suckle at the breast prior to surgery it is possible with commitment for him to taste and lick milk expressed onto the nipple and be fed with expressed breast milk by another feeding method. Many parents feel very satisfied having done this.  

There are several alternative cup and spoon type methods, cup feeding, and a supplemental nursing system. Breast pumps can be hired and the baby given mothers milk. Do talk to your midwife, cleft team feeding advisor or CLAPA supporter about this.  

Take it a week at a time and review the situation, deciding whether to continue for another week.  

Breast milk does not irritate the delicate tissue in the nose and throat as much as formula milk and can help to reduce the risk of ear problems developing.  

There are some booklets written specifically for mothers who wish to breastfeed their baby with a cleft. (see Other Help) 

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Many babies will need extra help to enable them to take sufficient nourishment in a reasonable time, say 30-40 minutes.  

You need a teat on which your baby can grip well and a good flow of milk. This can be achieved with an ordinary bottle, though the hole or holes in the teat may need to be enlarged or extra ones made. (For how to enlarge or make extra holes see Babies with a cleft lip - bottle feeding section.)  

If your baby is feeding slowly, it may be necessary to experiment with different teats as some manage better with one such as an orthodontic shaped teat. If using an orthodontic shaped teat the hole is best made on the non-cleft side and slightly towards the tongue so that milk is aimed downwards and away from the cleft. 

Others need a soft bottle which can be squeezed as the baby sucks to help the flow of milk . This may give you more control than an enlarged hole. Nursing your baby in a more upright position may help control the flow of milk and reduce air intake.  

Some babies may not have the energy to suck from a teat, and here a cup and spoon method may be helpful. Feeding from the Rosti scoop requires less effort from the baby.  

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The timing of the palate operation may vary from centre to centre, depending on the type of cleft and operation that your surgeon performs. This may mean that your baby is weaned , but still using a bottle for milk or other liquids.  

In some areas the surgeon prefers you not to use a bottle immediately after the palate operation so ask your team for advice, as you may need to get your baby used to a spoon bottle or short spouted trainer cup before the operation. The same may apply to a dummy.  

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