The Nature of Feeding in Infants With Unrepaired Cleft Lip and/or Palate Compared With Healthy Noncleft Infants

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doi: 10.1597/05-185
The Cleft Palate-Craniofacial Journal: Vol. 44, No. 3, pp. 321–328.

The Nature of Feeding in Infants With Unrepaired Cleft Lip and/or Palate Compared With Healthy Noncleft Infants

A.G. Masarei, B.App.Sc., Ph.D., M.R.C.S.L.T.
D. Sell, Ph.D., M.R.C.S.L.T., F.R.C.S.L.T.
A. Habel, M.B.Ch.B., F.R.C.P., M.R.C.P.C.H.
Michael Mars, D.Sc.(Hon.), Ph.D., B.D.S., F.D.S., D.Orth., F.R.C.S.L.T.
B.C. Sommerlad, M.B., F.R.C.S.(Eng.)
A. Wade, B.Sc., Ph.D., C.Stat., I.L.T.M.

Dr. Masarei was previously Specialist Speech and Language Therapist, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. Dr. Sell is Lead Speech and Language Therapist, North Thames Regional Cleft Centre, and Head of Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. Dr. Habel is Consultant Pediatrician, Dr. Mars is Lead Orthodontist, and Dr. Sommerlad is Lead Consultant Plastic Surgeon, North Thames Regional Cleft Centre, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. Dr. Wade is Senior Lecturer in Medical Statistics, Centre for Paediatric Epidemiology and Biostatistics Institute of Child Health, London, United Kingdom

Submitted November 2005; Accepted April 2006.

Objective: Feeding difficulties are reported widely in infants with cleft lip and/ or palate. There is, however, a paucity of objective information about the feeding patterns of these infants. This study compared patterns of feeding in infants with unrepaired cleft lip and palate with healthy noncleft infants of a similar age.
Setting: North Thames Regional Cleft Centre. The noncleft cohort was recruited from West Middlesex University Hospital, a general hospital with similar demographics.
Participants: Fifty newborn infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate who were referred to the North Thames Regional Cleft Centre participated. Parents of 20 randomly selected, noncleft infants agreed to participate.
Main Outcome Measures: Feeding patterns were rated using the Neonatal Oral Motor Assessment Scale. Additional objective information was collected using the Great Ormond Street Measurement of Infant Feeding (Masarei et al., 2001; Masarei, 2003).
Results: Infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate had less efficient sucking patterns than their noncleft peers had. They used shorter sucks (mean difference, 0.30 second; p < .0005), a faster rate of sucking (mean difference, 34.20 sucks/second; p < .0005), higher suck-swallow ratios (mean difference, 1.87 sucks/swallow; p < .0005), and a greater proportion of intraoral positive pressure generation (mean difference, 45.97% positive pressure; p < .0005).
Conclusions: This study demonstrated that the sucking patterns of infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate differ from those of their noncleft peers.

KEY WORDS: feeding, infants, pressure generation, sucking patterns, unrepaired cleft palate, unrepaired complete unilateral cleft lip and palate