Here is my 2cents worth regarding breastfeeding cleft-affected infants.  First, it seems to depend on where and how extensive is the cleft.  Babies who have cleft lips without a cleft palate often breastfeed well with just the breast tissue filling the cleft, or the mother's finger over it.  If it extends into the nose, it is harder.
For those babies with cleft hard palates, an obturator often works well to allow negative pressure to be maintained in the oral cavity,  but they cannot be used on a cleft soft palate because of gagging and choking.  One of the main reasons that negative pressure is necessary inside the baby's mouth is to hold the stretched nipple in place over the back of the tongue.  When negative pressure cannot be maintained within the infant's oral cavity, the jaws and tongue are not maintained back far enough on the breast to extract milk efficiently.  As the baby draws the jaw down in the classic suckle, air is drawn in through the cleft, and negative pressure is never attained or cannot be maintained.

This observation is after 30 years working with cleft-affected infants.  Since I have had one myself, I often get called to help these mothers.  I think anyone working with cleft-affected infants and babies with regards to breastfeeding should read the excellent booklet entitled, " The Controversial Issue of Breastfeeding Cleft-Affected Infants."  The booklets are in my office so I can't give you the information on how to get it tonight, but will post it later.

Our suck-genius, breastfeeding-zealot OT agrees with me and the booklet, as does the lactation consultant for Primary Children's Medical Center who sees cleft-affected infants on a daily basis.
Deanne, RN  IBCLC
NICU

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