Weaning advice for babies with cleft lip and / or palate

Introduction

This leaflet is aimed at parents or relatives of children born with a cleft. The aim is to give parents or relatives information and suggestions to help them wean their child.

Your cleft clinical nurse specialist will be able to advise you on the right time to wean your baby and this leaflet is to help support you with this guidance

In most cases there is no difference in the timeline for weaning a baby with a cleft and unless your cleft nurse suggests otherwise you can follow the usual NHS guidance for all babies.

Delaying weaning is not recommended as it is known that delayed exposure to solid food after 10 months of age can make the weaning process harder and take longer for your baby to accept.

Your aim is to introduce a varied and balanced diet.

Babies with a cleft lip

If your baby has a cleft lip, you can follow NHS recommended guidance for weaning, which is starting to wean your baby at six months unless you are advised otherwise.

Babies with cleft lip and palate or cleft palate only

Babies with a cleft of their palate can in some cases be slower to wean and your cleft clinical nurse specialist will be able to advise you if they feel it would be better to start the weaning process earlier.

In some cases, babies that have experienced issues with severe reflux there may be a need to wean earlier from 17 weeks. However, this should always be discussed with your cleft clinical nurse specialist and dietitian as the process will need closer monitoring.

Weaning your baby with a cleft palate should follow the standard expected route for weaning and there is no need to restrict your baby to purees only until after their cleft surgery. By offering mashed and lumpy foods as well as finger foods they learn in the same way as other babies to move the food around their mouth and swallow.

As mentioned, babies with a cleft palate should follow a standard weaning route bearing in mind the after-surgery advice is that for 3 weeks post palate surgery they will need to have soft foods[MC1]. With this in mind it is a good idea as they progress along their weaning journey to continue to offer foods of a pureed consistency, so they still find these foods familiar.

We recommended that you still occasionally feed your baby yourself from a spoon, so they are comfortable with this. However, we would not advise allowing a baby to spoon feed themselves for 3 weeks after-surgery, to allow optimum healing of the wound site.

It is expected and normal for babies with clefts to have foods coming out of their nose in the same way as you may have seen milk coming down their nose. Although this may look distressing at first it is not something to worry about and your baby will learn to cope with this as the weaning process develops. Be prepared with a cloth or bibs to catch the mess.

Signs your baby is ready for weaning

Showing interest in foods when you and others are eating.

Being able to stay in a sitting position and hold their head steady.

Good hand / eye co-ordination, if your baby can hold a toy and put it to their mouth this would suggest that with practice, they could do the same with food.

Types of weaning

Traditional weaning is when babies start with pureed foods and over time move onto mashed, lumpier foods and finger foods.

Baby-led weaning is when babies are given finger foods and feed themselves from the start.

There is no right or wrong method; some parents prefer baby-led weaning to spoon feeding whilst others choose to combine both methods.

Beginning to wean

At the beginning how much, your baby eats is less important than getting them used to the idea of eating and experiencing new tastes and textures.

Until a baby is one years old, they will still be getting most of their nutrients from breast milk or infant formula.

Slowly over time you can introduce new and varied foods and the amount your baby will take will increase. As the intake of food increases it is normal for the intake of milk to decrease.

Food acceptance develops from repeated exposure, which helps babies to become accustomed to new tastes as well as developing the necessary chewing skills.

How to start solid foods

It is a good idea to get your baby into a feeding routine, choosing one meal a day to begin with.

The baby will only take small amounts in the beginning, do not worry about this as the important thing is getting them used to new tastes, textures and learning how to move food in their mouth and how to swallow it. Over time this will develop to your baby having a full meal.

Allow plenty of time for first mealtimes.

Follow your baby’s pace, let your baby tell you if they have had enough or would like more.

Follow your babies cues for refusal if they turn away or become upset, do not force them to continue feeding, end the mealtime and try again the next day offering a different food but remember to offer the refused food again at a different time.

Babies should be seated in a highchair or booster chair at mealtimes, and it is a good idea to involve them in family mealtimes around the table so they can learn from seeing how others eat and enjoy foods.

Once you begin weaning you should continue to do this every day at the mealtime you have chosen. This does not have to be at an exact time but what fits your baby’s routine - therefore if you have chosen breakfast time, continue with this every day until you feel your baby has mastered this meal. You can then add in another meal.

Babies learn through repetition and routine, so it is important once you have started the weaning journey to continue this to achieve the best success for your baby.

Offering single foods at a time such as fruit or vegetables can help you to decide which foods your baby likes and dislikes. Always remember to offer sweet and savoury foods so your baby does not come to prefer some tastes to others. Remember to re-offer refused or disliked foods a few days later to see if as your baby’s weaning development continues, they may now enjoy food they previously refused.

Weaning is a suitable time to introduce a cup or beaker for drinking water, milk, or diluted squash. You can try a small open cup, Doidy cup or a free-flowing beaker such as the Tommee Tippee. Offering the beaker or cup at meals times and other times during the day can help encourage its use.

There are also weaning tools that you may wish to use to help such as net feeders, finger feeders and teething toys. These can be useful for first tastes. A small amount of food can be put in one of these and your baby can put it to their mouth by themselves or with assistance.

Whichever method you choose for weaning the important thing is to offer your baby a wide variety of foods to make sure their nutritional needs are met.

Things to remember

Keep mealtimes short, limiting them to around 15 minutes to start with.

Remain calm and positive.

Remember that babies will be guided by you and can notice your anxieties which can make them more likely to refuse or be less confident about trying new foods

Weaning is a gradual process and should be seen as a partnership between parent and baby. You will decide when and what to offer your baby to eat but your baby will decide when, if and how much they want to eat.

Every baby will follow a different weaning path so try not to worry if you feel the progress is slow. Seek support from your cleft clinical nurse specialist and health visitor as needed.

It is very normal for children to be less interested in eating if they are tired or unwell.

Offer small amounts of food and allow time for your baby to process, chew and swallow. It is normal for babies to spit some or all the food back out when first weaning. This is because their tongue is moving in and out, the process required for milk feeding. Weaning requires babies to use their tongue differently and therefore it takes time for them to learn to use an up-and-down and side–to-side motion.

It is also normal for some coughing or gagging to take place in the early days and this should be managed calmly so as not to scare your baby. Allow your baby to clear the food before offering further mouthfuls. Try adjusting the consistency of foods to see if this makes it more manageable for them.

Always stay with your baby when they are eating in case they start to choke.

Choking is different from gagging. Your baby may gag when you introduce solid foods.

If your baby is gagging:

• their eyes may water
• they might push their tongue forward (or out of their mouth)
• they might retch to bring the food forward in their mouth or vomit
• Try to remain calm a gentle rub or pat on the back may help clear the food.
• If the choking persists and you and baby are not able to clear the food further medical assistance should be sought.

Repetition and consistency are key to successful weaning.

Although the process can be messy it should be enjoyable and fun too!!

Resources

Your baby's first solid foods - NHS (opens in a new tab)

Cleft Lip & Palate Association (opens in a new tab)