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Clefting's Impact on Oral Feeding

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

March 6, 2017



What is the impact of a cleft lip and/or palate on oral feeding in infants?


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.  

Related Courses

Feeding in Cleft Lip and Palate: Surgical Interventions in the First Year of Life
Presented by Brenda Thompson, MA, CCC-SLP, BCS-S


Brenda Thompson, MA, CCC-SLP, BCS-S
Course: #10588Level: Intermediate1.5 Hours
  'I don't work with infants at this point, but I think it's nice to keep up on other areas of speech pathology in case I ever switch paths'   Read Reviews
Prenatal and postnatal care provided by a multidisciplinary craniofacial team to optimize feeding, growth and development outcomes is described in this course. Assessment and treatment approaches before and following surgical interventions, including those for mandibular distraction osteogenesis (MDO), cleft lip, and cleft palate, are shared.

Feeding in Newborns with Cleft Lip and Palate: Using Evidence and Experience as a Guide for Success
Presented by Brenda Thompson, MA, CCC-SLP, BCS-S


Brenda Thompson, MA, CCC-SLP, BCS-S
Course: #10403Level: Intermediate1 Hour
  'information was goodTouched on the main points'   Read Reviews
The role of the speech-language pathologist or other feeding specialist in promoting infant feeding efficiency for optimal growth and development is described in this course. Different types of clefts and their impact on newborn feeding and swallowing are discussed, along with components of the clinical feeding assessment and therapeutic interventions to facilitate feeding in infants with cleft lip/palate. (Part 2: Course 10588)

Thickened Liquids in Clinical Practice: The Plot “Thickens”
Presented by Angela Mansolillo, MA, CCC-SLP, BCS-S


Angela Mansolillo, MA, CCC-SLP, BCS-S
Course: #10497Level: Intermediate1 Hour
  'The speaker is very engaging and knowledgeable'   Read Reviews
Clinicians who utilize thickened liquids in their clinical practice are aware of their benefits, but what about the risks and contraindications? Advantages and disadvantages of thickened liquids are reviewed in this course with a focus on clinical outcomes, including impacts on medication administration, lung health, and hydration. Product types are evaluated to facilitate appropriate choices for individual clients.

Dysphagia in Neurodegenerative Disease
Presented by Debra M. Suiter, PhD, CCC-SLP, BCS-S


Debra M. Suiter, PhD, CCC-SLP, BCS-S
Course: #9732Level: Intermediate1 Hour
  'The presenter was very organized in her presentation'   Read Reviews
Dysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. This course discusses the underlying pathophysiology and appropriate treatment programs for each disease, as well as use of alternate methods of nutrition/hydration.

20Q: In the Thick of It - The International Dysphagia Diet Standardization Initiative (IDDSI)
Presented by Jennifer Raminick, MA, CCC-SLP, BCS-S, Danielle Ward, MA, CCC-SLP


Jennifer Raminick, MA, CCC-SLP, BCS-SDanielle Ward, MA, CCC-SLP
Course: #10756Level: Intermediate1 Hour
  'Short, but very informative'   Read Reviews
The importance of using IDSSI to provide standardized language when speaking about texture modification is discussed in this course. Comparisons of IDDSI and the National Dysphagia Diet (NDD), as well as IDDSI standards for pediatric vs. adult patients are presented. Additionally, potential barriers, solutions, and frequently asked questions related to implementation of IDDSI are described.

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