Breast Feeding for Cleft Lip and Palate Patients, Using the Hotz-Type Plate

Abstract

Objective: Oral-cavity feeding movements were analyzed during sucking and used to modify a Hotz-type plate to facilitate sucking in infants with cleft lip and palate. Design: Sucking movements were analyzed using lateral view cine radiography as three adults fed from a bottle. A Hotz-type plate was then modified to better isolate the oral cavity and to occlude the oral airway. The plate was then utilized indirect breast feeding by 10 babies. Outcome Measures: Sucking rate, amount of milk taken, and duration of use of the plate were assessed. Results: Wearing this plate, four babies with cleft lip and palate could suck their mother's breast, drinking about 22 g/trial. Conclusions: Although supplemental bottle feeding was required to provide enough nourishment, this is the first step to reaching ideal breast feeding situation for these patients.

Feeding intervention in cleft lip and palate babies: a practical approach to feeding efficiency and weight gain

“…Another study carried out by KOGO et al 13 , concluded that there was no significant difference in weight gain in bottle fed compared with cup and spoon fed babies, and recommended bottle feeding. According to SHAW et al 25 , squeezable bottles were more satisfactory, requiring less intervention, resulting in an increase in weight of the cleft babies.…”

“…Various methods of feeding cleft lip and palate babies have been investigated in previous studies to determine if weight gain and feeding efficiency could be improved 2,4,[9][10][11]13,14,17,19,22,23,25,29 . This aim of this study was to determine if syringe fed cleft babies gained more weight than those fed with cup and spoon and if feeding efficiency was improved.…”

“…Cleft babies are less able to suck efficiently 3,5,6,11,20,28 , have shorter sucks 13 , a faster rate of sucking, a higher suck swallow ratio 13 and an inability to generate a negative intraoral pressure 3,5 . These result in an inadequate intake of food, which results in a reduced weight for age and retarded growth 3,18,20,21 .…”

“…Various feeding devices have been used to feed these babies including the traditional feeding bottle, which may be rigid or squeezable with two types of teats (a regular Nuk and a cleft Nuk), a squeezable cleft palate nurser 8,13,25 , a traditional feeding bottle with a crosscut nipple 13,18,28 , the Hotz type Plate 12 , the Haberman feeder 28 , prosthetic obturator appliance 4,29 , nasogastric tube and cup and spoon feeding 9,10,12,17 . These devices have had different effects on the weight gained by these babies.…”

Soft Palate Movement During Sucking Behavior

“…Our previous report [8] demonstrated that children with a cleft lip and palate, unable to produce ordinary sucking pressure due to their palatal clefts, could be breast fed directly by use of a modified Hotz-plate [9], which has an acrylic ridge along the posterior ridge of the hard palate. This ridge was found to produce a tight contact with the dorsal surface of the tongue using the PG muscle and may have helped to form the oral cavity into the desirable ''closed box'' in those subjects, thereby maintaining sucking pressure.…”