Cleft Palate Analysis

Infants who have a cleft lip and/or cleft palate have craniofacial anomalies that affect their ability to efficiently consume nutrients. Specifically, these infants have openings on their lips and/or palate that make breastfeeding or obtaining fluids from standard bottles difficult. Consequently, management for feeding and swallowing is vital to ensure that these infants are receiving the necessary nutrients to grow and be healthy. The role of the speech language pathologist (SLP) is to facilitate the process of feeding for infants with a cleft lip and/or palate and for their families and/or caregivers. SLPs implement evidence-based practice by utilizing the most efficient products and techniques, and by providing nutritional advice to maximize
oral intake and enhance the overall quality of life for these infants.
A cleft is an abnormal opening on an anatomical structure that would typically be closed (Kummer, 2014).
Clefts develop during utero and can affect either the lips, the palate or both structures. Specifically, a cleft lip results from the philtrum not coming together properly. A cleft palate occurs when the roof of the mouth does not close normally which leaves a wide opening between the oral and nasal cavities (Kummer, 2014). These craniofacial anomalies typically occur within the first trimester of pregnancy (Shah & Wong, 1980) and are evident in 1 to 2 newborns per 1,000 births (Robin, Franklin, Guyton, Mann, Woolley, Waite, & Grant, 2006).
A cleft lip and/or cleft palate are caused by internal and/or external factors (Kummer, 2014). Internal factors include chromosomes or genetic disorders, while external factors can either be environmental or mechanical. Common environmental factors are cigarette smoke, the anti-seizure medication Dilantin, or viruses like Rubella. Mechanical factors refer to specific body positions. For instance, if a baby has his or her head down constantly in utero, the tongue will lie on the palate and cause it to form really wide. This position results in a cleft palate (Kummer,
2014).
Due to the abnormal development of these anatomical structures, infants who have a cleft lip and/or cleft palate have difficulty during feeds.
Infants with just a cleft lip may require a change in position to facilitate their ability to obtain fluids from a nipple on a bottle or from their mother’s breasts. However, infants who have both a cleft lip and cleft palate require more than a change in position. These infants cannot properly seal their lips around their mother’s nipples or the nipples of standard bottles to produce negative intraoral pressure to obtain nutrients (Clarren, Anderson, & Wolf, 1987). Therefore, breastfeeding and the use of standard bottles are inefficient and will result in prolonged feeding periods that are beyond 30 minutes. During this time, the infant takes in excessive air which may cause fatigue, nasal regurgitation, coughing, or gagging and a loss of engagement (Clarren et al., 1987). Consequently, these children do not consume adequate amounts of nutrition and have difficulty gaining weight. Thus, SLPs use adaptive management approaches such as feeding products, techniques and nutritional knowledge to help facilitate the process of feeding and swallowing for children who have a cleft lip and/or palate and for their families (Reid,
2004).
There are a variety of feeding products that SLPs can provide to infants who have a cleft lip and cleft palate to maximize the flow of breastmilk or formula and enhance the feeding process. The most common products used are the Dr. Brown’s Specialty feeding bottle, pigeon feeders, Medela Special needs bottle, Nuk orthodontic bottles, cups and spoons. Special bottles work best when infants have not had any surgical repairs. However, the transition to cups and spoons is favorable as the child approaches the first operational repair. Fundamentally, while these special feeding products are beneficial for infants who have a cleft lip and cleft palate, caution must be implemented while using them. This is primarily because some of these products can deliver an increased flow of liquids into the throat which can make breathing and swallowing difficult (Reid, 2004).