Study Examines Barriers, Supports to Facilitate Breast Milk Feeding for Infants with Cleft Lip/Palate

ACPAACPA News, Journal

  • Breast milk provision to infants with CL/P is slightly lower than national average
  • Infants with CL/P face multiple obstacles to successful oral feeding
  • Early diagnosis and educational resources help families prepare and be successful in providing breast milk to infants during first 6 months

CHAPEL HILL, N.C. / April 14, 2020 – Early diagnosis of cleft lip and/or palate (CL/P) and educational resources about breastfeeding were effective in helping mothers provide breast milk to their babies during the first six months of life according to a recent research study. The study, “Breast Milk Feeding Practices and Barriers and Supports Experienced by Mother–Infant Dyads With Cleft Lip and/or Palate”, was published in the April 2020 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“We found that although there are multiple barriers for infants with CL/P and their mothers in achieving breast milk feeding success, there are numerous medical and psychosocial resources that can improve outcomes,” said Lauren L. Madhoun, PhD, lead researcher.

The American Academy of Pediatrics recommends breast milk exclusively during the first six months of life for all infants. Some of the benefits of breast milk include a lower risk for otitis media, sudden infant death syndrome, and type 1 and 2 diabetes, and improved neurodevelopmental outcomes during the first years of school.

Infants with CL/P face multiple obstacles to successful oral feeding because the cleft palate inhibits the infant’s ability to create the negative suction to draw liquids into the mouth. Therefore, for infants with a palatal cleft, exclusive feeding at the breast is often not possible. However, pumping and providing breast milk through the use of specialty bottles can helpnursing mothers to overcome the physical obstacle that CL/P presents.

“Previous studies around this issue used small, limited samples of participants. Our study sought to address this gap by using a large U.S. sample of mothers and infants with CL/P,” Madhoun noted. “We collected data about breast milk provision via breast and bottle, feeding practices and attitudes, duration of breast milk provision, and barriers and supports to breastfeeding and breast milk provision. We hypothesized that the proportion of mothers of infants with CL/P engaging in breastfeeding and other forms of breast milk provision would be substantially lower than the national average for all infants.”

Researchers recruited mothers of infants with CL/P nationally via social media and the enrolling institution’s Cleft Lip and Palate Clinic. The study’s survey link was posted on various cleft palate parent organization websites, blogs, and social media sites. In addition, mothers of infants seen at the local Cleft Lip and Palate Clinic were given the option to complete the survey during a routine clinic visit. Infants were required to be between 8 and 14 months old at the time of the survey to determine whether breast milk was provided at least until 6 months of age.

The survey collected maternal and child demographics as well as the infant’s medical and surgical history. It also queried mothers about prenatal intentions to offer breast milk, if and for how long the infant fed at the breast, feeding practices, if and for how long the mother pumped, pumping practices, self-reported postpartum mental health concerns, and pressure and assistance from others to breastfeed and/or pump.

Mothers from 37 states participated in the study. While 70% percent of the mothers had planned to breastfeed, only 42% attempted to breastfeed following their baby’s birth. Similarly, 68% of mothers changed their feeding plans following the cleft diagnosis. Of these mothers, 48% decided to bottle-feed, and 20% decided to bottle-feed rather than feed through a combination of breastfeeding and bottle-feeding.

Barriers to breast milk provision differed based on the feeding method, but most mothers expressed concern about providing enough breast milk for their infants. Fifty-seven percent of mothers reported receiving help with feeding from at least one source, including lactation consultants, nurses, feeding therapists, online support groups, family, friends, organized breastfeeding support groups, or doctors. Overall, 46% of the mothers surveyed said that they provided breast milk—via breast or bottle—to their baby with CL/P until 6 months of age. In addition, mothers cited early CL/P diagnosis and family education as helpful ways for families to prepare for breastfeeding challenges.

“Overall, we found that breast milk provision rates for infants with clefts were slightly lower than national estimates of the general population of infants without clefting during the first 6 months of life,” Madhoun said. “However, when CL/P teams reach out and connect mothers with resources that can encourage and help facilitate breast milk provision, mothers are more successful in providing breast milk to their infants.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit