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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2012  |  Volume : 30  |  Issue : 1  |  Page : 47-50
 

Nature of feeding practices among children with cleft lip and palate


1 Unit of Pedodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
2 Unit of Orthodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
3 Dr. H. S. J. Institute of Dental Sciences and Hospital, Panjab University, Sector 25, Chandigarh, India

Date of Web Publication3-May-2012

Correspondence Address:
A Goyal
Unit of Pedodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.95581

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   Abstract 

Objective: To find out the nature of feeding practices among children with cleft lip and palate. Materials and Methods: A total of 155 subjects of less than 2 years of age with cleft lip and palate were chosen and divided into three groups according to their chronological age. Group I included 47 subjects (M=35, F=12) who were <6 months old, Group II included 56 subjects (M=36, F=20) aged between 6 months and 1 year, and Group III included 52 subjects (M=28, F=24) of age between 1 and 2 years. Both the parents of the subjects with cleft lip and palate were interviewed and the details of the existing feeding practice were recorded on a standard proforma. Chi-square test was applied to find out any significant difference in the feeding method between males and females. Results: Spoon feeding was found as the most common feeding practice method. Breast feeding was the second most common feeding practice method among Group I subjects, whereas bottle feeding was the second most common feeding practice method among Group II and III subjects. The difference in the feeding practice between male and female subjects in all the three groups was very negligible and statistically not significant. Conclusion: Spoon feeding was found as the most common feeding method practiced by the parents of children with cleft lip and palate.


Keywords: Cleft lip and palate children, feeding practices, breast feeding


How to cite this article:
Goyal A, Jena A K, Kaur M. Nature of feeding practices among children with cleft lip and palate. J Indian Soc Pedod Prev Dent 2012;30:47-50

How to cite this URL:
Goyal A, Jena A K, Kaur M. Nature of feeding practices among children with cleft lip and palate. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Aug 18];30:47-50. Available from: http://www.jisppd.com/text.asp?2012/30/1/47/95581



   Introduction Top


The goal in feeding an infant with a cleft lip or palate is similar to the goals in feeding any infant, maintaining nutrition in the first priority. The feeding difficulties in babies with cleft lip and/or palate are well documented; [1],[2],[3],[4],[5],[6] as many as 63% of them experience such difficulties [7] and most of these are related to reduced sucking efficiency. [8] There are plenty of feeding methods recommended in the literature for successful feeding in children with cleft lip and palate. Most health care workers agree that breast feeding is beneficial for both infant with cleft lip and mother. [9],[10],[11] But there are no data in the literature mentioning the actual feeding method practiced by the parents of such children. Thus, the present study was designed to find out the feeding methods practiced by the parents of babies with cleft lip and palate.


   Materials and Methods Top


A total of 155 subjects of less than 2 years of age with cleft lip and palate were included in the study. All these subjects were selected from patients with cleft, attending the Cleft Palate Clinic, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh. Syndromic cleft subjects were excluded from the study. The subjects were divided into three groups, i.e. Group I, II, and III, according to their chronological age. Group I included 47 subjects (M=35, F=12) aged <6 months, Group II included 56 subjects (M=36, F=20) aged between 6 months and 1 year, and Group III included 52 subjects (M=28, F=24) aged between 1 and 2 years. Both the parents of the subjects with cleft lip and palate were interviewed and the details of the existing feeding practice were recorded on a standard proforma which included name, age, sex, type of cleft, and present feeding methods practiced (that included exclusive breast feeding, bottle feeding, combined breast and bottle feeding, spoon feeding, glass feeding, and feeding by dropper and straw). The same investigator (MK) interviewed all the parents of subjects with cleft lip and palate and recorded the data.

The data were entered on a master sheet and Chi-square test was applied to find out any significant difference in the feeding method between males and females.


   Results Top


The type of feeding practice among male and female subjects of the three groups is described in [Table 1]. Among all the subjects (N=155), spoon feeding was the most common feeding practice method noted and none of the subjects had feeding practice by glass and straw. Breast feeding was the second most common feeding practice method among Group I subjects, whereas bottle feeding was the second most common feeding practice method among Group II and III subjects, i.e. children between 6 months and 2 years of age. The difference in the feeding practice between male and female subjects in all the three groups was negligible and statistically not significant.
Table 1: Nature of feeding practice among children with cleft lip and palate

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   Discussion Top


The problems of feeding a child with cleft lip and palate are very important for the the new mother and for the inexperienced maternity staff. [12] Recently, more attention has been turned to this area of cleft care, [13],[14] which was traditionally regarded as the responsibility of profession allied to medicine. [15] Most of the feeding difficulties are because of decreased efficiency of sucking. [8] The degree of difficulty in feeding varies with the severity of cleft lesion. [16] If the infant has only a small notch on the lip or split uvula, feeding may not be a problem. [16] However, infants with cleft palate will have feeding difficulties since a negative pressure cannot be generated within the mouth in order to facilitate sucking. [17] The inability to feed satisfactorily results from maternal stress and anxiety [4] and can be attributed to poor mother-infant bonding. [18] Also, failure to thrive is a recognized problem associated with patients with cleft lip and palate. [19],[20],[21]

As feeding is an immediate problem for newborn babies with cleft lip and palate, many feeding methods have been recommended in the literature. Some authors have presented short catalogues of feeding equipment or techniques that may help infants with clefts [22],[23] and others have advocated specific feeders for use in some or all clefting conditions. [3],[24],[25],[26],[27],[28]

Although little objective data exist on the effectiveness of feeding plates, these have been extensively advocated [4],[29] and many studies have reported enhanced feeding with the plate in shorter feeding times. [4],[30] The main drawback of these feeding plates is the repeated requirement of fabrication of new ones because of growth and maintenance of good oral hygiene which may not be followed. The alternative approach to the use of feeding plates is modifying the standard feeding techniques by careful positioning of the baby's head or by using cups and spoons or by a range of modified teats. Some centers favor the use of prosthetic obturation of the anatomical cleft palate to enhance feeding. [31],[32] Palatal obturation improves palatal seal in many patients and may improve the generation of negative pressure, [32] but is seldom associated with improper oral hygiene and sometimes even fungal growth on the palate when proper cleaning of the prosthesis is not followed.

Compressible (squeezable) plastic feeding bottles with narrow, long, cross-cut nipples have also been used with considerable success. [33] Gentle squeezing of the plastic bottle forces formula from the tip of the nipple, avoiding the necessity of the negative pressure created by sucking. [28] The Haberman feeder by Medela is commonly used in the United States, [34] and a type-P nipple and a Y-cut nipple with a long and wide shaft have been used widely in Japan. [16] According to Mizuno et al., [16] type-P nipple does not fully solve the feeding problems of infants with cleft lip and palate.

Most health care workers agree that breast feeding is the most beneficial for both infant and mother. [9],[10] Breast milk may confer some protection against otitis media [35] and is linked to higher scores on intelligence tests and language development. [36] In spite of all these benefits, there is little in the cleft literature to suggest that anything other than breast feeding is appropriate for cleft child. [3],[17],[27] Darzi et al., in a prospective randomized trial, showed that early postoperative breast feeding after cleft lip repair is safe, results in more weight gain at 6 weeks after surgery, and is more economical than spoon feeding. [37]

In the present study, spoon feeding was found to be the most common feeding method practiced by parents of children with cleft lip and palate. Prior to birth of their children, majority of mothers were motivated to breastfeed their child, but no attempt was made to enforce one particular method of feeding. The parents were encouraged to find the methods which best suited their baby by a process of trial and error. The goal in feeding an infant with a cleft lip or palate is similar to the goals in feeding any infant, i.e. maintaining nutrition in the first priority and finding a feeding technique as close to normal as possible is the second one. Mother's interest in breast feeding should never be summarily dismissed; in fact breast feeding is the most superior technique in certain conditions.


   Conclusion Top


Spoon feeding was found as the most common feeding method practiced by the parents of children with cleft lip and palate.

 
   References Top

1.Zickefoose M, Feeding problems of children with cleft palate. Children 1957;4:225-8.  Back to cited text no. 1
    
2.Williams AC, Rothman BN, Sedman IH. Management of a feeding problem in an infant with cleft palate. J Am Dent Assoc 1968;77:81-3.  Back to cited text no. 2
    
3.Kelly EE. Feeding cleft palate babies: Today's babies, todays methods. Cleft Palate J 1971;8:61-4.  Back to cited text no. 3
[PUBMED]    
4.Jones JF, Henderson L, Avery DR. Use of feeding obturator for infants with severe cleft lip and palate. Special Care Dent 1982;2:116-20.  Back to cited text no. 4
    
5.Trenouth MJ, Campbell AN. Questionnaire evaluation of feeding methods for cleft lip and palate neonates. Int J Paediatr Dent 1996;6:241-4.  Back to cited text no. 5
[PUBMED]    
6.Masarei AG, Sell D, Habel A, Mars M, Sommerlad BC, Wade A, et al. The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Cleft Palate Craniofac J 2007;44:321-7.  Back to cited text no. 6
    
7.Clarren SK, Anderson B, Wolf LS. Feeding infants with cleft lip, cleft palate, or cleft lip and palate. Cleft Palate J 1987;24:224-49.  Back to cited text no. 7
    
8.Spriesterbach DC, Dickson DR, Fraser FC, Horowitz SL, McWilliams BJ, Paradise JL, et al. Clinical research in cleft lip and palate: The state of the art. Cleft Palate J 1973;10:113-65.  Back to cited text no. 8
    
9.Weatherley-White RC, Kuehn PD, Mirrett P, Gilman JI, Weatherley-White CC. Early repair and breast feeding for infants with cleft lip. Plast Reconstr Surg 1987;79:879-85.  Back to cited text no. 9
    
10.Royal College of Midwives. Successful breastfeeding. 2 nd Ed. Edinburgh: Churchill Livingstone; 1991.  Back to cited text no. 10
    
11.White A, Freeth S, O'Brien M. Infant feeding 1990. OPCS London: HMSC; 1992.  Back to cited text no. 11
    
12.Curtin G. The infant with cleft lip or palate: More than a surgical problem. J Perinat Neonatal Nurs 1990;3:80-9.  Back to cited text no. 12
[PUBMED]    
13.Berkowitz S. Feeding your child. In: The cleft palate story. Chicago: Qunitessence; 1994.  Back to cited text no. 13
    
14.Breen M, Curtin G, Ursich C. Nursing considerations for children with craniofacial anomalies. In: Turvey TA, Vig KW, Fonesca RJ, editors. Facial clefts and synostosis, principles and management. Philadelphia: WB Saunders; 1996.  Back to cited text no. 14
    
15.A Midwife's Code of Practice. United Kingdom Central Council For Nursing, Midwifery and Health Visiting, 1991.  Back to cited text no. 15
    
16.Mizuno K, Ueda A, Kani K, Kawamura H. Feeding behaviour of infants with cleft lip and palate. Acta Paediatr 2002;91:1227-32.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17.Choi BH, Kleinheinz J, Joos U, Komposch G. Sucking efficiency of early orthopedic plate and teats in infants with cleft lip and palate. Int J Oral Maxillofac Surg 1991;20:167-9.  Back to cited text no. 17
[PUBMED]    
18.Nowak AJ, Smith WI, Erenberg A. Imaging evaluation of artificial nipples during bottle-feeding. Arch Pediatr Adolesc Med 1994;148:40-2.  Back to cited text no. 18
    
19.Ranalli DN, Mazaheri M. Height-weight growth of cleft children, birth to six years. Cleft Plate J 1975;12:400-4.  Back to cited text no. 19
    
20.Avedian LV, Ruberg RL. Impaired weight gain in cleft palate patients. Cleft Palate J 1980;17:24-6.  Back to cited text no. 20
[PUBMED]    
21.Pandya AN, Boorman JG. Failure to thrive in babies with cleft lip and palate. Br J Plast Surg 2001;54:471-5.  Back to cited text no. 21
[PUBMED]    
22.Pressland BM. Cleft lip and palate-2, Nursing Care. Nurs Times 1973;69:1406-7.  Back to cited text no. 22
[PUBMED]    
23.Shah CP, Wong D. Management of children with cleft lip and palate. Can Med Assoc 1980;122:19-24.  Back to cited text no. 23
    
24.Takagi Y, McCalla JL, Bosma JF. Prone feeding of infants with Pierre Robin syndrome. Cleft Palate J 1966;3:232-9.  Back to cited text no. 24
[PUBMED]    
25.Wood BG, Kevill GA. Nursing care of babies with cleft lip and palate. 1. The Pierre Robin syndrome. Nurs Times 1970;66:1385-9.  Back to cited text no. 25
    
26.Shirley WL, Cocke WM. A nursing device for use in cleft palate care. Plast Reconstr Surg 1971;48:83.  Back to cited text no. 26
[PUBMED]    
27.Pashayan H, McNab M. Simplified method of feeding infants born with cleft palate with or without cleft lip. Am J Dis Child 1979;133:145-7.  Back to cited text no. 27
    
28.Martin LW. A new 'gravity-flow' nipple for feeding infants with congenital cleft palate. Pediatrics 1983;72:244.  Back to cited text no. 28
[PUBMED]    
29.Radzek MK. Prosthetic feeding aids for infants with cleft lip and palate. J Prosth Dent 1980;44:556-61.  Back to cited text no. 29
    
30.Balluff MA, Udin RD. Using a feeding appliance to aid the infant with a cleft palate. Ear Nose Throat J 1986;65:316-20.  Back to cited text no. 30
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31.Oliver HT. Construction of orthodontic appliance for the treatment of newborn infants. Am J Orthod 1969;56:468-73.  Back to cited text no. 31
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32.Hemingway L. Breast feeding a cleft palate baby. Med J Aust 1972;2:626.  Back to cited text no. 32
[PUBMED]    
33.Paradise JL, McWilliams BJ. Simplified feeder for infants with cleft palate. Pediatrics 1974;53:566-8.  Back to cited text no. 33
[PUBMED]    
34.Turner L, Jacobsen C, Humenczuk M, Singhal VK, Moore D, Bell H. The effects of lactation education and a prosthetic obturator appliance on feeding efficiency in infants with cleft lip and palate. Cleft Palate Craniofac J 2001;38:519-24.  Back to cited text no. 34
[PUBMED]  [FULLTEXT]  
35.Paradise JL, Elster BA, Tan L. Evidence in infants with cleft palate that breast milk protects against otitis media. Pediatrics 1994;94:853-60.  Back to cited text no. 35
[PUBMED]    
36.Tayler B, Wadsworth J. Breast-feeding and child development at five years. Dev Med Child Neurol 1984;26:73-80.  Back to cited text no. 36
    
37.Darzi MA, Chowdri NA, Bhat AN. Breast feeding or spoon feeding after cleft repair: A prospective, randomized study. Br J Plast Surg 1996;49:24-6.  Back to cited text no. 37
    



 
 
    Tables

  [Table 1]


This article has been cited by
1 Role of obturators and other feeding interventions in patients with cleft lip and palate: a review
M. Goyal,R. Chopra,K. Bansal,M. Marwaha
European Archives of Paediatric Dentistry. 2014; 15(1): 1
[Pubmed] | [DOI]



 

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