Breastfeeding Creates a Strong Foundation of Health for Babies with Cleft

By Charlotte Steppling, Nutrition Program Manager, Operation Smile

Operation Smile
5 min readAug 25, 2020


Exclusive breastfeeding is recommended by healthcare professionals for at least the first 6 months following birth. In fact, the World Health Organization (WHO) recommends breastfeeding until 2 years old because the benefits continue throughout early physical development.

A mother in Wenshan, China, breastfeeds her baby after surgery.
A mother in Wenshan, China, breastfeeds her baby after surgery.

The perks and the power of breastfeeding are endless — not only is it free and ready at any time — but breast milk is loaded with antibodies that help babies fight off viruses and bacteria, which is critical in early months. A 2016 report published by UNICEF estimates that if babies were breastfed early and exclusively for the first 6 months following birth, more than 820,000 lives could be saved each year.

The Benefits of Breastfeeding Children Born with Cleft

Unfortunately, babies born with cleft lip and palate face challenges with breastfeeding. The gap in the lip or cavity in the palate caused by cleft may prevent a child from creating the necessary vacuum around the mother’s nipple to suckle at the breast efficiently. This may prevent the child from receiving colostrum, which is the earliest breast milk produced during the first few days after baby’s birth. It is the most important food of all for infants.

Without this important food, children born with cleft are susceptible to common ear and nasal infections. The inability to nurse also impacts the facial muscles that ultimately support speech development later in life.

8 month old Bismita, an undernourished girl from a mission in India
Bismita, an 8 month old baby in India who arrived at our mission site in need of nutrition assistance and surgery for her cleft condition.

It is vitally important that the child be as healthy as possible before the surgeries that can repair the cleft conditions are performed. It is always heartbreaking when we are unable to operate on a child because of inadequate weight gain due to undernourishment or a disease that could have been prevented if the child had received the proper nutrition that a mother’s milk provides.

My Top 10 Breastfeeding Strategies

I recommend the following simple yet effective strategies to improve breastfeeding support and services that all mothers, but in particular those with children born with cleft, can apply to help their children grow strong and healthy.

A mother in Madagascar feeds her child formula with a spoon.
A mother in Madagascar feeds her baby with a spoon.
  1. Immediate skin-to-skin care for a minimum of one hour after birth is one of the most effective methods for promoting and initiating breastfeeding for all mothers, not just those with babies born with cleft. Many health facilities are opting for “Rooming-In” methods where babies and mothers are kept together during their hospital stay, strengthening the bond between the mother and baby.
  2. It is important to remember that adequate hand washing with soap is extremely important before breastfeeding a baby to reduce the risk of transmitting bacteria to a nursing child.
  3. Mothers should receive practical support to enable them to initiate and establish breastfeeding and manage common breastfeeding difficulties. Empowering and coaching mothers during their first interactions with their baby is essential.
  4. It is important that mothers receive guidance on how to express breast milk as a means of maintaining lactation, especially if the baby has difficulty latching on to the breast. Any amount of breast milk is beneficial.
  5. Fortunately, for many babies with a cleft lip or palate breastfeeding is often possible. Mothers may need to experiment with finding the ideal position that allows the child to form a strong vacuum.
  6. The child may have to be burped often because babies with cleft often swallow more air than other babies.
  7. It is often possible for the mother to gently plug the hole in the lip to improve suction.
  8. Mothers can learn to use breast pumps to express breast milk and spoon or cup feed the baby.
  9. If it becomes obvious that breastfeeding is not practical, there are also special feeding devices that have been created to help mothers provide breast milk to their child and ensure they can receive the wonderful benefits of breast milk.
  10. Mothers should be supported to practice responsive feeding as part of nurturing care, which involves responding to a baby’s feeding cues, both of hunger and satiation.
Pitchaya, a little boy from Thailand sucks on a bottle from his grandmother.
Pitchaya, a little boy from Thailand, sucks on a bottle from his grandmother.

I encourage facilities providing maternity and newborn services to establish a clearly written breastfeeding policy that is routinely communicated to their staff and explained to parents. It is essential that health care facility staff feel competent in the guidance they are providing to new mothers, especially those with children born with cleft conditions.

People around the world are celebrating the amazing benefits of breastfeeding, while continuing the fight to ensure women have the support they need to breastfeed. At Operation Smile we want to ensure the health and well being of our patients and their families.

Working with a mother and her baby who was unable to breastfeed, utilizing a special feeding device to help the child gain we
Here I’m working with a mother and baby unable to breastfeed, utilizing a special feeding device to help the child gain weight.

This year, we are committed to creating a world where every mother has the support she needs to breastfeed; no one breastfeeds alone — we ALL have a role to play in supporting breastfeeding.

As Nutrition Program Manager with Operation Smile, Charlotte Steppling is responsible for the development of the organization’s nutrition strategy and guiding the implementation of nutrition programs for all Operation Smile countries. Charlotte has lived in Madagascar for the past 8 years, first arriving to the island to serve as a Peace Corps volunteer. She then transitioned into a role with Operation Smile Madagascar and created the comprehensive nutrition programs that responded to the need of the numerous malnourished



Operation Smile

We are a global nonprofit bridging the gap in access to essential surgeries & healthcare, starting with cleft surgery and comprehensive care.