Feeding Infants with Cleft Lip and/or Palate in Brazil: Suggestions to Improve Health Policy and Research

Abstract

Objective : To verify feeding resources used prior to corrective surgery among cleft babies from Brazil and to discuss suggestions to improve common feeding problems around the world. Design : Cross-sectional descriptive study conducted at eight medical centers. Participants : A total of 215 parents or guardians of cleft children. Methods : Interview based upon a prevalidated questionnaire. The chi-square test and comparison of means by analysis of variance were used; significance level adopted was 5% (P < .05). Results : Feeding guidelines were provided in the maternity unit to 53% of the families. Breast-feeding was encouraged among 80% of mothers, predominantly in the South (P = .016). However, follow-up after maternity discharge was not appropriately carried out and failure to breast-feed occurred in 78% of families. The feeding tube was used in 21%. According to families, for those who used the ordinary nipple, it was considered the best option by the majority (29%). Conclusion : Neonatal feeding in cleft babies is a global challenge. Reports about the difficulties encountered and successful experiences would be helpful to disseminate strategies and stimulate research directed at the large-scale applicability of neonatal feeding for cleft babies on public health. This study detected the need to increase professional training and emphasizes the need for public policies addressing neonatal referral to specialized care wherever possible. It also stimulates research into using an ordinary nipple as another resource for feeding cleft babies and suggests an international discussion about specific recommendations for humanized primary health care.

Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty

“…The concern with feeding the children with cleft lip and palate is present since birth, due to involvement of the oral cavity (8)(9) .…”

Feeding practices of children aged 0 to 24 months with clefts attending a specialized hospital in Uganda

“…Uganda, Brazil and Norway reported similar breastfeeding rates of less than half (11,20,21). Not breastfeeding is a disadvantage because breast milk is the only nutrition option for children if their mothers cannot afford appropriate breast milk substitutes.…”

“…Most (50%) preferred the specialized (squeezable) soft bottle given to them by CoRSU because they could regulate the flow of milk into the child's mouth and this improved their child's feeding. Similarly, mothers in Brazil also used multiple feeding techniques including tubes, bottle nipples, cups, spoons, droppers and syringes although most mothers preferred the ordinary bottle with a nipple (6,20). Likewise, in a recent systematic review comparing feeding methods for children with cleft, the squeezable bottle improved feeding (33).…”

Risk factors and the prevention of oral clefts

“…23,24 Recommendations and reviews have been published regarding methods and resources for different types of cleft. 22,25,26,27 Notwithstanding, inadequate feeding is still a common problem. 13,24,28,29,30,31 A high rate of adherence to appropriate feeding and adequate growth is related to systematic monitoring of patients.…”