Weight Gain in Children with Cleft Lip and

Weight Gain in Children with Cleft Lip and Palate without Use of Palatal Plates Presented by Lisa Sharp-Gomez Research Article by Renato da Silva Freitas, Andrey Bernardo Lopes-Grego, Helena Luiza Douat Dietrich, Natacha Regina de Moraes Cerchiari, Tabatha Nakakogue, Rita Tonocchi, Juarez Gabardo, Eder David Borges da Silva and Antonio Jorge Forte 1 Center for Integral Assistance of Cleft Lip and Palate, Federal University of Parana , Cuitiba, PR, Brazil 2 School of Medicine, Yale University, New Haven, CT 06510, USA

What is a Cleft Lip? �Cleft Lip can be unilateral or bilateral

What is a Cleft Palate? �A Cleft Palate can involve hard palate, soft palate or both. It can occur with a cleft lip.

Clefting can result in: �Short, fast, uncoordinated or ineffective sucking. �Entrance of milk in the nasal cavity �This can cause sneezing and loss of formula �Excessive air ingestion �Lower weight gain �Shorter length (stature)

Study Background � This study was done in Brazil in 2012 at the Center for Integral Assistance of Cleft Lip and Palate with input from the Harvard School of Medicine � 112 patients ◦ 56 males ◦ 56 females � Followed � None from Birth to 1 year of the participants were fitted with a palatal plate or obturator.

What is a palatal plate A palatal plate (or obturator) is an individually fitted appliance inserted into the mouth to allow the infant to form a suction while feeding.

Is a Palatal plate necessary for good growth? �None of the children seen in the Center for Integral Assistance of Cleft Lip and Palate were fitted with a palatal plate �It was felt that education in proper feeding technique was adequate to insure appropriate nutrition and growth during the first year of life.

Methods: �Study ◦ ◦ participants classified by: Birth date Gender Cleft classification Type of milk consumed �Breast, formula or combination ◦ Length of exclusive breastfeeding ◦ Age of solid food consumption ◦ Monthly weight during the first year of life

Data Comparison: �Data gathered was compared to the data published by the World Health Organization with regards to average weight gain in children during their first year of life. �Data was gathered retrospectively from patients seen at the center from 2008 – 2009.

Results: �Formula was most commonly used – 36% of sample �Combination breast milk and formula used by 25% of sample �Exclusive breast milk was used by 8. 9% of the sample �It was felt by the researchers that there were parental difficulties collecting breast milk and that there was a lack of education available on breastfeeding a child with a cleft lip or palate. �Average for solid food introduction was 8 months

Results, cont: �Both boys and girls weight about 200 g less than average at birth �Boys weights lagged behind by almost 900 g at 3 months, but reached the WHO 50 th%ile by 10 months. �Girls weights lagged behind by 750 g at 3 months, but reached the WHO 50 th%ile by 9 months.

Weight comparison for boys

Weight comparison for girls

WHO comparison for girls

WHO comparison for boys

Discussion �Due to impaired sucking abilities, children with clefts have higher rates of malnutrition. �The majority children required ‘mechanical support’ to facilitate the flow of milk. �https: //www. youtube. com/watch? v=ER To. Vry 4 i. Zc

Discussion, cont. �The study found no statistical differences in the weights of children who used palatal plates and those who didn’t, so therefore did not recommend universal use of the plate. �The study supports corrective surgery between 9 -12 months.

Conclusion �It was determined that the type of cleft lip/palate and the type of milk consumed had no influence on weight gain or growth. �Factors which supported weight gain and growth were individually selected feeding methods, support, education, integrated multi professional care and regular follow ups.

Questions: �After listening to this research, what is your opinion about the use of palatal plates? �Do you feel that the weight gains at the clinic are adequate? �Comments? Questions?