Different feeding methods for cleft lip and palate-a systematic review

Abstract

AimChildren born with cleft lip or palate usually face many difficulties in feeding. Therefore, proper feeding methods are necessary for those children. The aim of this review is to compare different feeding methods for CLP (cleft lip and palate) as well as evaluate the best method for them.MethodsThis study covered the articles between 2000 and 2020. Related articles were selected and discussed for further extraction of data.ResultsUse of syringe, paladai bottle and bottle which is squeezable was considered best before the surgery. While the suction method was considered the best after the surgery.ConclusionThe suction method could be appropriate for CLP children, but the result showed that alternative methods were considered well.

Keywords

Review

Cleft lip and palate (CLP) are inherited deformities, which can affect lip, palate, or both.¹ causing errors in facial fusion development in embryo.² due to modifications in the normal development of primary as well as the secondary palate.³ These children experienced many difficulties including deficiency of nutrition, front teeth deformities, otitis media and change or delay in the development of speech. It is a very challenging process to feed the CLP children and in nursing, the most important task is to educate parents about successful feeding.⁴ Type and severity of cleft are the bases for feeding complexity in CLP infants. At the start, gain in weight can be a problem for nutritional deficiency and based on gender, they can have different problems.^5,6 When these children face such problems, they cannot develop normally and failed to adopt the social behavior, so they became incapable of accepting different social behaviors. In children, the nutritional problem is a general behavioral problem (Ashby JM: Feeding therapy and techniques for children with cleft lip/palate. C 2011. Available at: http://opensiuc.lib.siu.edu/cgi/viewcontent), which is observed in 25–50% of healthy infants.
Feeding difficulty is the most frequently reported problem concerned with CLP. These include the absence of effective sucking because of the failure of proper negative pressure, chocking and milk vomiting via nasal cavity due to defects in the palate and facial structure resulting in less intake of food.⁷ Children with CP (Cleft palate) faced more difficulties in feeding.⁸ As a consequence, these children have the poor status of nutrition compared to others and gain weight improperly.^7,9 Furthermore, these complications have negative impacts on children’s development and growth.¹⁰ Various methods are present to solve these problems in oral clef infants. Supplementary feeding along with breastfeeding is advised for infants to overcome their nutritional value.¹¹ Surgery is required for many reasons, including feeding.
The major distress for parents is feeding, as their children were diagnosed with a cleft lip/palate.¹² At the start, monitoring infant nutrition and weight is the main priority.⁷ Surgery is considered the early treatment for patients with CLP. For lip palate, surgery is advised by three months, and for palate cleft 9 or 12 months are recommended, as the chronology of the method needs some changes, which depend on the center.¹³ It is also important for the children to have proper nutrition so they can bear the different factors of surgery such as stable weight gain without changing health and the ability to receive anesthesia safely.¹⁴ It is predicted that after surgery, children will face fewer feeding problems because many oral structures will be repaired. After surgery (palatoplasty), suction is recommended instead of BF/bottle for 6 weeks. Several centers followed protocols in which nipples and bottles were forbidden for 30 days.¹⁵ Generally used techniques to aid in oral feeding for CP and CL infants include oral facilitation, positioning, pacing and assisted fluid delivery and variations in the fluid viscosity.
Based on the available literature, the aim of this systematic review is to compare different feeding methods for children with cleft lip and palate and to evaluate the best feeding method for children before and after surgery.

Materials and Methods

Search StrategyThe search of the literature was carried out from 2000 to 2020. The search was executed in the PubMed/ Science Direct and Google Scholar databases because they contained most of the publications in this field. The search was conducted using the following Mesh terms: ‘‘Cleft palate; cleft lip; lip and palate cleft; feeding methods for cleft; feeding methods for lip and palate cleft’’.Selection CriteriaPapers, which compared different methods of feeding recommended for cleft children with the level of evidence 1b to 4 as proposed by the American Speech-Language-Hearing Association (ASHA) were included in this review. Those studies that described syndromes linked with CLP were excluded. For further integration, a manual search was conducted in chosen papers.Data AnalysisThe authors reviewed the articles to assess whether they meet the criteria or not. Then they read the full articles for extraction of data. The chosen data were then discussed by the authors.

Results

Initially, related articles were searched. Various articles were excluded on the basis of abstract and title because they were not comparing the different feeding methods of CLP children. After discussion by the authors, 9 studies were selected for this systematic review. These studies discussed the different conditions of feeding and linked methods. The characteristics of different feeding methods included were: methods which required BF and suction, do not require suction cup, feeding route alteration i.e., nasogastric tube, paladai, syringe and spoon and the attributes/parameters that were assessed in these studies were: performance of feeding, complication and time of feeding, growth and nutritional gain, volume and acceptance of ingested food, fistula presence and related complications, pain, analgesia, duration of stay in hospital and costs. Although breastfeeding is encouraged for CLP children, most of them did not perform well with bottle feeding and BF before surgery.

Discussion

It has been reported that using a syringe for feeding is easy, practical, spent less time, less vomit and cause significant gain in weight.¹⁷ Ravi et al. used a less known, alternative technique method, in which effects of different feeding methods i.e., with bottle, spoon and paladai on the pattern of weight gain were compared. Children fed with paladai showed greater improvements.¹⁸ Though paladai use is not common, those studies are important which evaluate less common methods because these techniques ease the intake of food and energy-efficient for CLP children.¹⁹ Similarly, a study compared the spoon vs. bottle and spoon and exhibited very similar results. The group which use spoon and bottle showed better result and group that use spoon faced discomfort.²⁰ When syringe/spoon was compared with bottle/BF, although they represented similar results but parents showed more satisfaction with bottle/ BF.²¹ The methods that did not use suction caused irritation which lead to tearful and restless. Suction is very important.²² and create bonding between child and mother and also develop oral motor skills.²³ A study said that those children fed via the nasogastric tube were more stable and they discharged from the hospital earlier. Parents were more satisfied while the other group which fed by using bottle showed rejection in feeding and prolonged and frequent feeding.²⁴ After surgery, the tube can damage the repair and may cause pain.²⁵ A study reported that the use of a spoon presented best as it showed less escape and more acceptance of food.¹⁶ Another benefit with spoon feeding is that it provides high contraction of the muscle and oral stimulation as compared to use of cup.²⁶

Conclusion

After surgery, the appropriate method of feeding for the children who have cleft lip/palate is suction. However, in some cases the alternative techniques e.g., syringe, bottle and paladai may be performed well. However, more studies are required for feeding methods before surgery.

Declarations

References

1. Jesus MSV, Kings C. Perceptive study of oral and nasal vowels in individuals with cleft palate. J Bras Fonoaudiol. 2002;3(11):121-126.
   PubMed · Google Scholar
2. Cardim VL. Craniofacial growth. In: Altmann E, ed. Labiopalatine Fissures. Pro-Fono; 2005:31-38.
   PubMed · Google Scholar
3. Marques RMF, Lopes LD, Khoury RBF. Embryology. In: Altmann E, ed. Cleft Lip and Palate. Pro-Fono; 2005:3-23.
   PubMed · Google Scholar
4. Scott RS, Terri K. Nutrition in children. In: Scott RS, Terri K. Lippincott Williams & Wilkins; 2009:807.
   PubMed · Google Scholar
5. Kasten EF, Schmidt SP, Zickler CF, et al. Team care of the patient with cleft lip and palate. Curr Probl Pediatr Adolesc Health Care. 2008;38:138-158. doi:10.1016/j.cppeds.2008.02.003
   Article · PubMed · Google Scholar
6. Gahagan S. The development of eating behavior: biology and context. J Dev Behav Pediatr. 2012;33:261-271. doi:10.1097/dbp.0b013e31824a7baa
   Article · PubMed · Google Scholar
7. Amstalden-Mendes LG, Magna LA, Gil-da-Silva-Lopes VL. Neonatal care of infants with cleft lip and/or palate: feeding orientation and evolution of weight gain in a nonspecialized Brazilian hospital. Cleft Palate Craniofac J. 2007;44(3):329-334. doi:10.1597/05-177
   Article · PubMed · Google Scholar
8. Naz F, Mir S, Bali SK, Nazir S. Awareness of feeding plates among the parents of cleft lip and palate children in the Kashmiri population: an original research. Int J Appl Decis Sci. 2018;4(4):67-69.
   PubMed · Google Scholar
9. de Vries IAC, Breugem CC, van der Heul AMB, et al. Prevalence of feeding disorders in children with cleft palate only: a retrospective study. Clin Oral Investig. 2014;18:1507-1515.
   PubMed · Google Scholar
10. Pandya AN, Boorman JG. Failure to thrive in babies with cleft lip and palate. Br J Plast Surg. 2001;54:471-475. doi:10.1054/bjps.2001.3618
    Article · PubMed · Google Scholar
11. Goyal M, Chopra R, Bansal K, Marwaha M. Role of obturators and other feeding interventions in patients with cleft lip and palate: a review. Eur Arch Paediatr Dent. 2014;15:1-9. doi:10.1007/s40368-013-0101-0
    Article · PubMed · Google Scholar
12. Araruna RC, Vendruscolo DM. Nutrition of children with cleft lip and cleft palate: a bibliographic study. Rev Lat Am Enfermagem. 2000;8:99-105.
    PubMed · Google Scholar
13. Bertier CE, Trindade IEK, Silva Filho OG. Lip and palate primary surgeries. In: Trindade IEK, Silva Filho OG, eds. Cleft Lip and Palate: An Interdisciplinary Approach. Santos; 2007:73-85.
    PubMed · Google Scholar
14. Wyszynski DF. Cleft Lip and Palate: From Origin to Treatment. Oxford University Press; 2002.
    PubMed · Google Scholar
15. Trettene AS, Mondini CC, Marques IL. Feeding children in the immediate perioperative period after palatoplasty: a comparison between techniques using a cup and a spoon. Rev Esc Enferm USP. 2013;47:1298-1304.
    PubMed · Google Scholar
16. Ize-Iyamu IN, Saheeb BD. Feeding intervention in cleft lip and palate babies: a practical approach to feeding efficiency and weight gain. Int J Oral Maxillofac Surg. 2011;40:916-919. doi:10.1016/j.ijom.2011.04.017
    Article · PubMed · Google Scholar
17. Ravi BK, Padmasani LN, Hemamalini AJ, Murthy J. Weight gain pattern of infants with orofacial cleft on 3 types of feeding techniques. Indian J Pediatr. 2015;82:581-585. doi:10.1007/s12098-014-1668-0
    Article · PubMed · Google Scholar
18. Di Ninno CQMS, Moura D, Raciff R, Machado SV, Rocha CMG, Norton RC. Characterization of the pattern of velopharyngeal closure in patients with cleft palate. Rev Soc Bras Fonoaudiol. 2011;16:417-421.
    PubMed · Google Scholar
19. Assuncao AG, Pinto MA, Peres SP, Tristao MT. Immediate postoperative evaluation of the surgical wound and nutritional evolution after cheiloplasty. Cleft Palate Craniofac J. 2005;42:434-438.
    PubMed · Google Scholar
20. Augsornwan D, Surakunprapha P, Pattangtanang P, Pongpagatip S, Jenwitheesuk K, Chowchuen B. Comparison of wound dehiscence and parents’ satisfaction between spoon/syringe feeding and breast/bottle feeding in patients undergoing cleft lip repair. J Med Assoc Thai. 2013;96(4):61-70.
    PubMed · Google Scholar
21. Mullen R. The state of the evidence: ASHA develops levels of evidence for communication sciences and disorders. ASHA Lead. 2007. doi:10.1044/leader.ftr4.12032007.8
    Article · PubMed · Google Scholar
22. Kummer AW. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. Cengage Learning; 2008.
    PubMed · Google Scholar
23. Kent R, Martin V. Nasogastric feeding for infants who have undergone palatoplasty for a cleft palate. Paediatr Nurs. 2009;21:24-29. doi:10.7748/paed2009.12.21.10.24.c7401
    Article · PubMed · Google Scholar
24. Hughes J, Lindup M, Wright S, Naik M, Dhesi R, Howard R. Does nasogastric feeding reduce distress after cleft palate repair in infants? Nurs Child Young People. 2013;25:26-30. doi:10.7748/ncyp2013.11.25.9.26.e324
    Article · PubMed · Google Scholar
25. Silva EB, Rocha CMG, Lage RR. The baby with cleft lip and palate: interdisciplinary intervention. In: Jesus MSV, Di Ninno CQMS, eds. Cleft Lip and Palate: Fundamentals for Speech Therapy Practice. Roca; 2009:10-28.
    PubMed · Google Scholar
26. Kim EK, Lee TJ, Chae SW. Effect of unrestricted bottle-feeding on the early postoperative course after cleft palate repair. J Craniofac Surg. 2009;20:1886-1888. doi:10.1097/scs.0b013e3181b2d1d1
    Article · PubMed · Google Scholar
27. Madhoun LL, Crerand CE, Keim S, Baylis AL. Breast milk feeding practices and barriers and supports experienced by mother-infant dyads with cleft lip and/or palate. Cleft Palate Craniofac J. 2020;57(4):477-486. doi:10.1177/1055665619878972
    Article · PubMed · Google Scholar

Tables