Feeding interventions resulting in best growth for children with cleft

Feeding Interventions Resulting in Best Growth Outcomes for Children with Cleft Lip and/or Palate
Emily White, B.A. & Abbie Olszewski, Ph.D., CCC-SLP
University of Nevada, Reno
Introduction
•  Cleft lip and/or palate (CLP) is the most
common craniofacial defect.
•  Infants with CLP have less efficient and shorter
sucks, a faster rate of sucking, a higher suck
swallow ratio, an inability to generate negative
intraoral pressure, and often times cannot latch
onto the breast for feeding.
Results
Dependent Variable
Results
Authors & Research
Design
Participants
Bessell, Hooper, Shaw, Reilly,
Reid, & Glenny (2011)
Randomized trial
N = 292
• Infants with CLP and
nonsymdromic
• Birth to 6 months
Increased weight gain post
surgery
(Breastfeeding vs. spoon feeding)
Breastfeeding
Mean difference 0.47
(95% CI 0.20 to 0.74)
Databases used: Cochrane Collaboration, CleftPalate Craniofacial Journal, PubMed.
Brady, Brine, Bull, Liechty,
Manatunga, & Rickard (1994)
Randomized control trial
N = 30
• Infants with cleft palate
• Birth to 64 days old
Increased weight gain
(Comparing squeezable bottle vs.
rigid bottle)
Not statistically significant
(p < 0.21)
Search Terms: Cleft palate, cleft lip, feeding,
breastfeeding
Systematic literature review performed.
•  These difficulties result in inadequate nutrition,
thus leading to reduced weight and rate of
growth compared to non-cleft children.
Goyal, Jena, & Kaur (2012)
Correlational study
Increased weight gain
(Breast, bottle, breast + bottle,
Spoon, dropper, glass, straw, most
popular intervention)
Spoon feeding
•  Several interventions are used to address
feeding difficulties for children with CLP.
N =155
• Infants with CLP and
nonsyndromic
• Birth to 2 years
Ize-Iyamu & Saheeb (2011)
Randomized control trial
N = 57
• Infants with CLP
• 6 to 14 weeks
Increased weight gain
(Comparing syringe vs. cup and
spoon)
Syringe with breast milk/formula
(p < 0.02)
N = 99
• Infants with CLP and
nonsyndromic
Increased weight gain
(Comparing squeezable bottle vs.
rigid bottle)
Not significant
(p < 0.001)
Presence of a specialized health
visitor service
Beneficial effect on weight gain
noted in assisted feeding groups
Increased weight gain
(Comparing Haberman vs.
Haberman, obturator, & education)
Haberman, obturator, & education
with breast milk,
Cohen’s d = 0.14 (large)
Clinical Scenario
Shaw, Bannister, & Roberts
(1999)
Randomized control trial
Emily is a graduate clinician who hopes to
work with infants with cleft lip/palate (CLP).
Feeding interventions for this special
population include the use of modified bottles
(rigid and flexible), cup and spoon, syringe,
modified feeding positions, obturating plates
(prostheses), and breastfeeding.
Breastfeeding is the most popular method of
feeding an infant. If breastfeeding was not an
option, due to difficulties related to CLP, would
another method produce similar results in
weight gain and development?
PICO Question
Does breastfeeding (I) an infant with a cleft lip
and/or palate result in more rapid growth (O),
compared to the use on non-breastfeeding
techniques (i.e. rigid and flexible bottles, cup
and spoon, syringe, modified feeding
positions, obturating plates/prostheses) (C) for
infants with clefts (P)?
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Methods
Turner, Jacobsen, Humenczuk,
Singhal, Moore, & Bell (2001)
Prospective, reversal design
N=8
• Infants with CLP
• Birth to 2 years
Discussion
Breastfeeding:
•  Exclusive, sustained breastfeeding was not accomplished by any of
the mothers included in this research.
•  Using breast milk with selected feeding intervention enhanced
anthropometric measures.
Bottle feeding:
•  Bottles were the most commonly used method of feeding intervention
used by parents of children with CLP.
•  Use of rigid or squeezable bottle resulted in comparable weight gain
among infants with CLP.
•  Squeezable bottles were easier to use and required less modification
compared to other bottles.
Obturator:
•  Palatal obturators were most successful when used in combination
with other feeding interventions.
Cup and Spoon:
•  A less efficient feeding method compared to other widely available
interventions.
Syringe:
•  Success comparable to bottle use.
Education for parents:
•  Anthropometric measures and parental satisfaction increased when
education and support was provided by a specialist (dietician, nurse,
specialized consultant).
Clinical Bottom Line:
•  Mothers should breastfeed an infant with CLP, if possible. If breastfeeding is
not possible, a squeezable bottle containing breast milk is the next best option.
Having access to education provided by a CLP or nutrition specialist increases
anthropometric gains and parental satisfaction.
•  Education and assistance provided by a specialist decreased hospital stay,
decreased hospital costs, and increased clinical management of individual
cases.
Inter-rater reliability: 87-93%
References
Bessell, A., Hooper, L., Shaw, W.C., Reilly, S., Reid, J., & Glenny, A.M.
(2011). Feeding interventions for growth and development in infants
with cleft lip, cleft palate or cleft lip and palate (Review). Cochrane
Database of Systematic Reviews, 2, 1-34.
doi: 10.1002/14651858.CD003315.pub3
Brady, M., Brine, E.A., Bull, M.J., Liechty, E.A., Manatunga, A., &
Rickard, K.A. (1994). Effectiveness of two feeding methods in
improving energy intake and growth of infants with cleft palate: A
randomized study. Journal of the American Dietetic
Association, 94(7), 732-739. http://0wx2mz2qh4I.search.serial
solutions.com.innopac.library.unr.edu/OpenURL_local?sid=Entrez:Pub
bMed&id=pmid:8021413
Goyal, A., Jena, A.K., & Kaur, M. (2012). Nature of feeding practices
among children with cleft lip and palate. Journal of Indian Society of
Pedodontics and Preventive Dentistry, 30(1), 47-50. doi:
10.4103/0970-4388.95581
Ize-Iyamu, I. N., & Saheeb, B.D. (2011). Feeding intervention in cleft
lip and palate babies: A practical approach to feeding efficiency and
weight gain. International Journal of Oral & Maxillofacial Surgery, 40,
916-919. doi: 10.1016/j.ijom.2011.04.407
Shaw, W. C., Bannister, R. P., & Roberts, C.P. (1999). Assisted feeding
is more reliable for infants with clefts: A randomized trial. Cleft
Palate-Craniofacial Journal, 36(3), 262-286.
www.cpcjournal.org.innopac.library.unr.edu/doi/pdf/10.1597/15451569%281999%29036%3C0262%3AAFIMRF%3E2.3.CO%3B2
Turner, L., Jacobsen, C., Humenczuk, M., Singhal, V.K., Moore, D., &
Bell, H. (2001). The effects of lactation education and a prosthetic
obturator appliance on feeding efficiency in infants with cleft lip and
palate. Cleft Palate-Craniofacial Journal, 38(5), 519-524.
doi: http://www.cpcjournal.org/doi/abs/10.1597/15451569%282001%29038%3C0519%3ATEOLEA%3E2.0.CO%3B2

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