Question
What is the impact of a cleft lip and/or palate on oral feeding in infants?
Answer
With a cleft of the lip, there is decreased anterior seal which can result in anterior loss and decreased negative and positive pressures. With a cleft to the palate, there is oral-nasal communication which contributes to several issues. With a cleft of the hard and soft palate, there is decreased ability to affect the negative pressure component of sucking because the oral seal is decreased. This may decrease the effectiveness and efficiency of feeding. There is possible anterior fluid loss, decreased volume extraction per suck, poor bolus collection and piecemeal posterior transfer. With a cleft to the hard palate, there may be a decrease in the compression component of sucking because the tongue has a reduced superior surface of which to work against. This may affect the volume compressed out per suck as well as posterior transfer. With an opening into the nasopharynx, formula or breast milk can move upward causing nasal regurgitation which may affect respiration and comfort.
Overall, the impact can include the following:
- decreased negative and/or positive pressure per sucking
- decreased efficiency possibly resulting in longer feeding times
- increasing anterior loss
- reduced ability for bolus collection and posterior transfer with possible piecemeal delivery to the pharynx which can affect the suck-swallow-breathing pattern
- increased nasal regurgitation
- increased air swallowing which can contribute to increased emesis and premature satiation
With that, there may be decreased volume of nourishment that the infant obtains and maintains for overall nutrition, hydration, and growth. All of this combined may affect the nutrition and hydration needed to support appropriate growth as well as the infant's overall medical status, health, development and surgical timing.
Please refer to the SpeechPathology.com course, Cleft Lip and Palate: Supporting Oral Feeding from Birth through Palatoplasty, presented in partnership with Cincinnati Children's for more in-depth information on strategies designed to improve a student's reading comprehension.
