Clinical Feeding Evaluations

When a baby is born with a cleft lip and palate or cleft palate, he/she will often have special feeding needs. Babies with cleft lip only (no palate involvement) typically do not have special feeding needs.

When there is a cleft in your baby’s palate, there is an opening between the mouth and nose. This opening keeps the baby from making the suction that is needed to pull milk from a nipple. As a result, even though the baby is able to suck and swallow, he or she needs a special bottle to compensate for the lack of suction.

Lack of suction also makes breastfeeding very hard, which can lead to not enough weight gain. We encourage mothers to pump breastmilk and feed their baby with a special bottle.

In addition to a hard time creating suction, your baby may have:

  • Milk leaking from the nose during feedings due to the opening between the mouth and nose.
  • A weak suck and may tire more easily.
  • Gas from swallowing too much air.

Our Cleft & Craniofacial Center feeding specialists will work closely with you and your baby to ensure that feedings are successful and your baby gains weight as expected. Additional information regarding feeding a baby with cleft palate is available from the following resources:

  • Feeding an Infant with Cleft Lip and Palate
    Cleft Palate Only Patient/Parent Education Handout
  • Cleftline
  • Breastfeeding an infant with cleft lip only

When does my baby need to see a feeding specialist?

The Cleft & Craniofacial Center team typically recommends the following schedule:

Initial Feeding Consult

Recommended 1-2 weeks after discharge from the hospital, this visit is often coordinated with an evaluation with your child’s cleft surgeon.

Weekly Weight Checks

  • Weekly weight checks at your child’s primary doctor’s office.
  • The clinic will fax weight gain information to the Cleft & Craniofacial Clinic
  • If weight gain does not progress as expected (see chart below), a follow-up feeding consult is recommended. Please call (612) 813-6888 to schedule.
  • If weight gain is adequate, weekly weight checks are no longer necessary after your child’s 2-month well child check.
  • Transitioning to a cup for palate repair
    As your child gets ready for surgical repair of the palate, it is important that he or she is no longer drinking from a bottle or using a pacifier. The sucking motion and contact from the nipple may interfere with healing.
  • A cleft palate is typically repaired between 8 and12 months of age. Your child needs to be drinking all liquids from a free flowing cup (no bottle) for at least one month before surgery.
  • A Cleft & Craniofacial Center feeding consult is typically recommended to assist with the introduction of a free flowing cup. This is often coordinate with follow-up appointments such as a post-operative PE (ear) tube check-up.
  • If your child continues to struggle with transitioning to a cup, a feeding consult with a speech or occupational therapist may be recommended.

How do I know if my child is gaining enough weight?

Your baby’s weight should be checked weekly, preferably on the same scale each time. When your baby starts to steadily gain weight, the Cleft & Craniofacial Center may recommend less frequent weight checks.

Age

Minimum Recommended Weight Gain

10-14 days

Return to birth weight

1-4 weeks

Gain 4-7 oz. per week

1-3 months

2 pounds per month

3-6 months

1 pound per month

6-9 months

¾ pound per month

9-12 months

½ pound per month

If you have any questions or concerns about your child’s weight gain, please do not hesitate to contact the Cleft & Craniofacial Center at (612) 813-6888.


How to schedule a feeding consult

Appointments for all of our Cleft & Craniofacial Center teams may be scheduled by contacting the clinic assistant at (612) 813-6888.

  • When should I call the Craniofacial Center?
    Please call the clinic (612-813-6888) if you have any of the following:
  • Bottle feeding times take longer than 40 minutes.
  • Coughing, choking or gagging with feedings.
  • Poor weekly weight gain.
  • Less than five wet diapers per day.
  • A hard time using or finding the right bottle.
  • If your child has a life-threatening emergency, please call 911.

Additional Resources

The Cleft Palate Foundation “Cleftline”

(800) 242-5338