A Systematic Review of Feeding Interventions for Infants with Cleft Palate

Abstract

Objective Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions. Methods A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type. Results Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth. Conclusions Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial.

Bottle-feeding techniques for children with cleft lip and palate experiencing feeding difficulties

“…In the case of CLP, there is a passage leading from the oral cavity to the fragile part of the nasal septum. Ulceration is likely to occur when the nipple makes contact near the nasal septum during bottle-feeding [ 20 ]. Therefore, the need for treatment is assessed by confirming whether there are any abnormalities in the oral cavity.…”

Supporting Parents Through a Cleft Palate

“…Several special bottles and nipples are available for bottle-feeding assistance for babies with cleft lip and palate. A 2021 systematic review examined various devices and techniques used to improve feeding for infants with cleft palate (Penny et al, 2021). Specialty bottles, alternative feeding systems (cup, spoon, or syringe feeding), and obturator (dental prosthesis to seal the cleft) were examined.…”

“…Squeezable bottles introduce more into the baby's mouth for those who suck poorly. Optimal weight gain is the goal and needs to be monitored closely (Penny et al, 2021). Postsurgery, new feeding skills may need to be acquired.…”

Current Practice Patterns and Training Pathways for Feeding Infants with Cleft Palate

“…Infant-driven systems allow the infant to independently compress the nipple to extract milk, while assisted delivery systems require a feeder to compress the nipple or bottle. There has been an increase in the use of infant-driven bottles 13 with the Dr. Brown's Medical Specialty Feeding System (Dr. Brown's) being one of the first bottles offered to infants with cleft palate. 9 Other specialty feeders include the Medela Special Needs Feeder (Haberman), Enfamil Cleft Lip/Palate Nurser (Mead Johnson), and the Pigeon baby bottle by Respironics (Pigeon).…”