Current Practice Patterns and Training Pathways for Feeding Infants with Cleft Palate

Abstract

Objective To examine the current trends and practices across disciplines for feeding infants with cleft palate with or without cleft lip and to describe provider training within this area Design Prospective survey Setting ACPA approved cleft palate teams and healthcare providers in the United States and Canada Participants Interdisciplinary providers that regularly provide feeding services to infants with cleft palate Intervention 50-item survey designed and distributed electronically via the ACPA Main Outcome Measures Information on provider demographics and practice patterns Results 76 respondents included providers in North America that have either currently or previously served on a cleft palate team. The majority of respondents were in speech-language pathology (49%) or nursing (38%) disciplines, worked in an outpatient setting (70%), and received no information (68%) regarding cleft palate feeding in their academic training. While specific practice patterns were relatively consistent across the respondent cohort, provider characteristics were significantly associated with squeezing the Haberman ( p = .013) and likelihood of collaboration with other providers when counseling parents/caregivers ( p = .039). Conclusions While provider characteristics varied, there were similar practice patterns observed across disciplines. Future research is needed explore training related to feeding knowledge as well as practice patterns in locations with a lower patient volume.

Current Postoperative Feeding Practices Following Surgical Repairs for Infants With Cleft Palate

“…This discrepancy between the literature and practice may be due to members of cleft teams relying on clinical expertise rather than research when making decisions and forming protocols. 20 In light of existing literature showing no connection between bottle feeding and fistula rate, 3,10,11 further research is needed to determine (a) which factors drive these postoperative feeding recommendations, (b) if there is a difference between using a bottle that requires suction versus only compression, and (c) how surgical integrity can be maintained with less restrictive protocols. It may be challenging for teams to update their protocols as new evidence emerges if their current incidence of fistulae is low.…”

“…Despite evidence that bottle feeding does not cause fistula formation, results from this survey demonstrate many teams are still opting to implement restrictive postoperative feeding protocols. This discrepancy between the literature and practice may be due to members of cleft teams relying on clinical expertise rather than research when making decisions and forming protocols 20 . In light of existing literature showing no connection between bottle feeding and fistula rate, 3,10,11 further research is needed to determine (a) which factors drive these postoperative feeding recommendations, (b) if there is a difference between using a bottle that requires suction versus only compression, and (c) how surgical integrity can be maintained with less restrictive protocols.…”

“…Themes arising from semi-structured interviews with a small group of expert feeding providers for infants with cleft palate were explored in this survey. 17 The 50-question survey included 3 sections: (1) respondent demographics, (2) provider practice patterns, and (3) training and education within this area. The survey was piloted to ensure face and content validity, and the questions were revised accordingly.…”

“…Approval to conduct the research was granted by the University of Wyoming Institutional Review Board. Themes arising from semi-structured interviews with a small group of expert feeding providers for infants with cleft palate were explored in this survey 17 . The 50-question survey included 3 sections: (1) respondent demographics, (2) provider practice patterns, and (3) training and education within this area.…”