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in Communication Disorders
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Cleft Lip and Palate
Swallowing/Feeding Treatment

General Findings

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE) 
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.5 Cleft Palate & Velopharyngeal Abnormalities
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
Added: July 2011
 
Description
This guideline provides recommendations for the assessment and treatment of cleft palate and velopharyngeal abnormalities. The target audience for this guideline is speech-language pathologists. Recommendations are based on randomized controlled trials (Level A Evidence), well-conducted clinical studies (Level B Evidence), or expert opinion (Level C Evidence). 
 
Recommendations
Recommend that speech-language pathologists work collaboratively with health professionals in the management of dysphagia and feeding (Level A Evidence). 
 
  
 
 
 
Evidence-Based Systematic Reviews
Effectiveness of Pre-Surgical Infant Orthopedic Treatment for Cleft Lip and Palate Patients: A Systematic Review and Meta-Analysis
Papadopoulos, M. A., Koumpridou, E. N., et al. (2012).
Orthodontics & Craniofacial Research, 15(4), 207-236.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2013

Description
This is a review and meta-analysis of randomized controlled trials and prospective clinical trials investigating the effects of pre-surgical infant orthopedics (PSIO) on developmental and craniofacial measures for infants with cleft lip and palate.

Conclusions
For infants with cleft lip and palate "PSIO treatment seems to have little effect on the feeding ability and subsequent growth (investigated through weight and height)" (p. 231).

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Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review
Uzel, A., & Alparslan, Z. N. (2011).
Cleft Palate-Craniofacial Journal, 48(5), 587-95.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of randomized controlled trials and controlled clinical trials investigating the efficiency of presurgical infant orthopedics (PSIO) on long-term outcomes in children with cleft lip and palate.

Conclusions
"PSIO with passive and active appliances had no positive effects on feeding or consequent nutritional status in patients with UCLP [unilateral cleft lip and palate]" (p. 592).

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Feeding Interventions for Growth and Development in Infants with Cleft Lip, Cleft Palate or Cleft Lip and Palate
Bessell, A., Hooper, L. et al. (2011).
Cochrane Database of Systematic Reviews (2).
 
This review meets the criteria for a high-quality evidence-based systematic review. 
Added: July 2011
 
Description
This is a review of randomized controlled trials investigating the effects of feeding interventions on growth, development and parent satisfaction for infants with cleft lip and palate. 
 
Conclusions
  • Five studies were included which examined various feeding interventions. While there is no evidence to support or refute the type of bottle for best growth outcomes, the authors indicated that squeezable bottles may be easier to use than rigid ones as feeding intervention for infants with cleft lip and/or palate.
  • No evidence was found to support the use of maxillary plates for infants with a unilateral cleft palate.
  • No evidence was found to assess the effects of maternal advice or support.

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Benchmarking Clinical Practice Against Best Evidence: An Example from Breastfeeding Infants with Cleft Lip and/or Palate
Mei, C., Morgan, A. T., et al. (2009).
Evidence-Based Communication Assessment and Intervention, 3(1), 48-66. 
 
This review meets the criteria for a high-quality evidence-based systematic review. 
Added: July 2011
 
Description
This is a review of studies investigating the breastfeeding of infants with cleft lip and/or palate. Levels of evidence were assigned as follows: Level 1 (based on a randomized controlled trial [RCT]); Level 2 (based on an RCT with the lower limit of the confidence interval below a meaningful benefit); Level 3 (based on a non-randomized study with a control group); Level 4 (based on a non-randomized study in which outcomes are compared with previous evidence); Level 5 (based on a single-subject design). 
 
Conclusions
  • Support for breastfeeding and occlusion of the cleft to facilitate lip seal was found for infants with cleft lip (Level 4 Evidence).
  • Support for breastfeeding was found for infants with cleft lip and palate (Level 4 Evidence).
  • Support for breastfeeding with infants with cleft palate was weak (Level 4 and 5 Evidence).
  • Based on the limited evidence, future research is warranted.

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Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 

Client/Patient/Caregiver Perspectives

 
Satisfaction with Treatment Outcome in Bilateral Cleft Lip and Palate Patients
Oosterkamp, B. C., Dijkstra, P. U., et al. (2007).
International Journal of Oral and Maxillofacial Surgery, 36(10), 890-5.
Added: July 2012

Description:
This is a case-control study of 74 individuals with bilateral cleft and lip palate (BCLP) examining satisfaction with treatment outcomes and quality of life compared to age-matched controls.

Conclusions

  • Thirty to forty-five percent of BCLP respondents indicated they continued to have concerns about speech, intelligibility, nasal breathing, hearing and drinking.

  • "Quantitative ratings did not demonstrate differences in satisfaction between BCLP patients and controls" in functional areas such as speech, hearing and drinking.

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The Effects of Lactation Education and a Prosthetic Obturator Appliance on Feeding Efficiency in Infants with Cleft Lip and Palate
Turner, L., Jacobsen, C., et al. (2001).
Cleft Palate-Craniofacial Journal, 38(5), 519-24.
Added: July 2012

Description:
This is a prospective study of eight breastmilk bottle-fed newborn infants with cleft lip and/or palate.  This study reports on the effects of lactation education and a prosthetic obturator appliance on feeding efficiency.  In addition, mothers' satsifaction with feeding and swallowing outcomes linked to the intervention were reported.

Conclusions
The majority of mothers surveyed reported high satisfaction in response to questions that addressed success in feeding their baby, that the baby ate in a normal fashion, that the baby received adequate amounts of milk with each feeding, and that the baby was gaining weight appropriately post-intervention.  

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Parents' Experiences of Having a Child with Cleft Lip and Palate
Johansson, B., & Ringsberg, K. C. (2004).
Journal of Advanced Nursing, 47(2), 165-173.
Added: July 2012

Description:
This is a phenomenographic qualitative study of 20 families who had at least one child with a unilateral or bilateral cleft lip and/or palate. The study described parents' experiences with a child with a cleft lip and/or palate and examined parents' perceptions of encouragement and support, both social and mental, from professionals, family, and friends.

Conclusions

  • Informants reported stress associated with conflicting information provided by the craniofacial team and the ward staff.  Specifically, the craniofacial team indicated that breasfeeding would be difficult whereas the ward staff encouraged breastfeeding.

  • Informants indicated that the workload was too large and it was time-consuming to feed a baby with a cleft lip and/or palate while also caring for siblings.

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Neonatal Feeding of Infants Born with Cleft Lip and/or Palate: Parental Perceptions of Their Experience in South Wales
Oliver, R. G., & Jones, G. (1997).
Cleft Palate-Craniofacial Journal, 34(6), 526-32.
Added: July 2012

Description:
This is a survey of 100 parents of children born with cleft lip and/or palate.  The study examined the parents' perceptions of service provided to help with feeding while in the hospital and on discharge.  Speech therapists were amongst the professionals who provided advice on feeding.

Conclusions

  • "Almost two thirds of parents of clelft lip and cleft lip and palate infants felt that feeding help given in [the] hospital was satisfactory, whereas just over half of parents of cleft palate infants were happy with feeding support" (p. 528).

  • "Of those parents who were concerned about their infant's feeding at home, half of the parents of cleft lip infants failed to obtain satisfactory help, and just over two thirds of cleft palate infants and just under a quarter of cleft lip and palate infants still did not receive satisfactory help.  Of those who believed that they had not received sufficient help and advice, most said that they needed practical help rather than support" (p. 528).

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Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review
Uzel, A., & Alparslan, Z. N. (2011).
Cleft Palate-Craniofacial Journal, 48(5), 587-95.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of randomized controlled trials and controlled clinical trials investigating the efficiency of presurgical infant orthopedics (PSIO) on long-term outcomes in children with cleft lip and palate.

Conclusions
PSIO had no effect on mothers' satisfaction during the first year of life.

» See full summary and quality ratings




 
 
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