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Med Travelers - December 2019

Clefting's Impact on Oral Feeding

Ann Clonan, M.Ed, CCC-SLP, Brenda Thompson, MA, CCC-SLP, BCS-S

March 6, 2017

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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.


ann clonan

Ann Clonan, M.Ed, CCC-SLP

Ann Clonan, M.Ed, CCC-SLP, is the Inpatient Clinical Manager in the Division of Speech-Language Pathology at Cincinnati Children's Hospital and Medical Center with 25 years experience. She specializes in providing service for communication/development, feeding and swallowing (clinical and instrumental) to infants (and their caregivers) throughout the inpatient environment with a primary focus in the level IV medical-surgical Neonatal Intensive Care Unit (NICU). She also provides services to those infants/families with their transition to Neonatal Follow up Clinic and the Craniofacial Center. She has completed training for NDT and NICAP.


brenda thompson

Brenda Thompson, MA, CCC-SLP, BCS-S

Brenda Thompson, MA, CCC-SLP, BCS-S, is a full-time Speech-Language Pathologist at Cincinnati Children's Hospital and Medical Center with 20 years experience.  She is on the inpatient team of Speech Pathologists and is dedicated to the level IV medical-surgical Neonatal Intensive Care Unit (NICU) and provides additional follow-up care for infants in the craniofacial center. In her role, she provides clinical feeding and swallowing and instrumental swallowing evaluations using videofluoroscopy (VFSS) and Fiberoptic Endoscopy (FEES) to identify swallow function and assist with determining interventions to support safe feeding.  In addition, she provides ongoing care to support feeding, swallowing and global infant development and provides caregiver education to support parent-infant interaction during feeding and play. She is a board certified specialist in swallowing and swallowing disorders from the American Speech-Language Hearing Association.  In addition, she is a certified/reliable examiner in the Neonatal Oral Motor Assessment Scale (NOMAS) and the Nursing Child Assessment Satellite Training (NCAST). Ms. Thompson does many lectures and seminars on a state and national level in the areas of swallowing and swallowing disorders, neonatal feeding, feeding and swallowing in medically-fragile infants and toddlers, and cleft palate and craniofacial anomalies and their impact on feeding and swallowing.  


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