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Feeding methods for children with cleft lip and/or palate: a systematic review
Giesse Albeche Duarte1, Ramon Bossardi Ramos2, Maria Cristina de Almeida Freitas Cardoso1
1Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-graduação em Ciências da Reabilitação - Linha Musculoesquelética, Porto Alegre, RS, Brazil.
Insights
Feeding difficulties are common in children with cleft lip and palate (CLP). This review compares feeding methods, finding alternative methods beneficial pre-surgery and suction methods post-lip repair, with varied results post-palatoplasty.
Area of Science:
- Pediatric Surgery
- Speech-Language Pathology
- Nutritional Science
Background:
- Children with cleft lip and palate (CLP) frequently experience feeding difficulties due to impaired sucking and swallowing.
- Appropriate feeding methods are crucial for the optimal development of children with CLP.
Purpose of the Study:
- To systematically review and compare feeding methods for children with CLP before and after surgical repair.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, LILACS, SciELO, Google Scholar) from 1990 to 2015.
- Included studies compared feeding methods for CLP, published in English, Spanish, or Portuguese.
- Excluded studies involving associated syndromes, orthopedic interventions, or surgical technique comparisons.
Main Results:
- Preoperatively, squeezable bottles, syringes, and paladai bottles showed improved feeding performance.
- Post-lip repair, suction methods demonstrated better feeding outcomes.
- Post-palatoplasty, results varied, with some studies favoring alternative feeding routes, others suction, and some spoon feeding.
Conclusions:
- Alternative feeding methods can be advantageous before cleft lip and palate surgical repair.
- Suction-based methods are generally more beneficial after lip repair surgery.
- Optimal feeding methods post-palatoplasty remain a subject of debate, requiring further investigation.
Introduction:
Feeding difficulties in children with cleft lip and palate (CLP) are frequent and appear at birth due to impairment of sucking and swallowing functions. The use of appropriate feeding methods for the different types of cleft and the period of the child's life is of utmost importance for their full development.
Objective:
Review studies comparing feeding methods for children with CLP, pre- and postoperatively.
Methods:
The search covered the period between January 1990 and August 2015 in the PubMed, LILACS, SciELO, and Google Scholar databases using the terms: cleft lip or cleft palate and feeding methods or breastfeeding or swallowing disorders and their synonyms. This systematic review was recorded in PROSPERO under number CRD42014015011. Publications that compared feeding methods and published in Portuguese, English, and Spanish were included in the review. Studies with associated syndromes, orthopedic methods, or comparing surgical techniques were not included.
Results:
The three reviewed studies on the period prior to surgical repair showed better feeding performance with three different methods: squeezable bottle, syringe, and paladai bottle. Only one study addressed the postoperative period of cleft lip and/or palate repair, with positive results for the feeding method with suction. Likewise, the post-lip repair studies showed better results with suction methods. After palatoplasty, two studies showed better performance with alternative feeding routes, one study with suction method, and one study that compared methods with no suction showed better results with spoon.
Conclusion:
The studies show that prior to surgical repair, the use of alternative methods can be beneficial. In the postoperative period following lip repair, methods with suction are more beneficial. However, in the postoperative period of palatoplasty, there are divergences of opinion regarding the most appropriate feeding methods.
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