Examining Milk-Thickening Practices for Infants With Cleft Palate: A Scoping Review

A common intervention to address aspiration and reflux in infants is thickening milk. However, thickening milk may further complicate feeding management for infants with cleft palate using adaptive feeding methods. The purpose of this scoping review was to identify and describe the types of milk thickener used for infants with cleft palate (with or without cleft lip) and the feeding modalities through which thickened milk is administered.

A comprehensive scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Five databases were searched: PubMed, Scopus, CINAHL, Google Scholar, and EBSCO Open Dissertations, in addition to citation searching. Records were limited to English-language publications with no date restrictions. Both peer-reviewed and gray-literature sources were included. After removing 868 duplicates, 2,282 records were screened by title and abstract. Sixty-four full-text articles were assessed for eligibility.

One study met the inclusion criteria. Milk thickening was used as an intervention for infants with isolated Pierre Robin sequence and cleft palate. The thickener used was a modified corn-based flour at approximately 3% concentration to achieve a thicker liquid consistency. The thickened milk was offered via a bottle with latex nipples of varying hole sizes (original, intermediate, and 1-mm) depending on the infant's needs. Despite only one study meeting the inclusion criteria by specifying thickener type and/or feeding modality, 11 tutorial and seminar articles that discussed milk thickening as an intervention strategy in this population were identified. However, these articles lacked any information on the type of thickener and feeding modality, and none implemented the intervention with infants.

Although milk thickening is described as a strategy in several tutorial and seminar articles, there is a paucity of empirical evidence to support milk thickening as a feeding intervention strategy for infants using cleft-adapted feeding methods.