Birth Defects

Infants born with birth defects can have a range of physical and developmental abnormalities, from very mild to more severe. Breast milk is still important nutrition for these infants, and in fact, may be especially beneficial for infants with certain birth defects who are often at higher risk for developmental delays and respiratory and other infections. Breastfeeding can also help to strengthen jaw and facial muscles, which could benefit babies with low muscle tone.

However, due to these infants’ physical and developmental differences, mothers may face some challenges in establishing and maintaining breastfeeding. Providers should work to ensure that mothers of infants with birth defects have adequate support to maximize their ability to provide them with breast milk.

How might birth defects affect breastfeeding mothers and babies?

Several of the most common birth defects, including Down syndrome, cleft lip and/or palate, and congenital heart disease, can affect an infant’s ability to breastfeed due to the associated physical and developmental features.

• Infants with Down syndrome (Trisomy 21) can have hypotonia (low muscle tone) which can lead to abnormal or weakened control of the oropharyngeal structures, contributing to an uncoordinated and/or weak suck, or difficulty swallowing, similar to those experienced by premature infants (For more information see ABM Protocol 16).
• In infants born with a cleft lip and/or a cleft palate, the oral cavity may not be adequately separated from the nasal cavity during feeding, which can make it difficult to create the suction needed to breastfeed successfully. This may result in the infant getting tired easily while breastfeeding or requiring a longer time to feed, which can affect growth and nutrition status (For more information, see ABM Protocol 17 [PDF-281KB]). Other difficulties may include nasal regurgitation (milk comes out of the nose) and aspiration (milk enters the airway).
• Some infants born with a congenital heart defect or disease may not be able to feed at the breast right after birth due to complications, such as hypoxia (low levels of oxygen in the blood). Once these babies are stable, breastfeeding is usually possible and beneficial.

Is it safe for an infant born with a birth defect to breastfeed?

Yes, with adequate support. Depending on the type and severity of the birth defect, some infants will be able to feed at the breast, while others may need to receive breast milk from a bottle or other feeding device, such as a supplemental nursing system (a feeding device delivering supplemental milk at the breast via tubing), cup, or syringe. Mothers of infants with some birth defects will likely need extra support in establishing and maintaining breastfeeding. These infants will also need to be closely monitored to be sure they are receiving enough calories to gain enough weight.

For most infants with birth defects, breast milk is still the optimal source of nutrition.