Avaliação da alimentação em crianças com fissura de lábio e/ou palato atendidas em um hospital de Porto Alegre

Eating and swallowing disorders in children with cleft lip and/or palate

Introduction. Cleft lip and palate are complex congenital anomalies of the orofacial system of children. Feeding and swallowing problems occur with varying degrees in children with cleft lip and/or palate. Aim. The aim of this paper was to review the literature and available evidence regarding the types of eating and swallowing disorders that can be identified in children with cleft lip and/or palate, as well as a description and types of compensatory strategies and interventions to alleviate difficulties. Methods. Insight into the relevant literature was performed by specialized search engines on the internet and insight into the electronic database. Results. The extent of the cleft is related to the severity of eating and swallowing disorders, so the most common problems are decreased oral sensitivity, cough, choking, nasal regurgitation, difficulty in sucking, laryngotracheal aspiration due to inadequate airway protection during swallowing, which may result in pneumonia and lung damage. Feeding and swallowing difficulty is also a source of stress for parents. Conclusion. Choking, coughing, nasal regurgitation, laryngotracheal aspiration, excessive air intake can lead to dehydration, malnutrition, but also the need for alternative feeding methods Therefore, it is of great importance to identify the problems of feeding and swallowing in a timely manner, along with modifications of the feeding method.

Symptoms of dysphagia in children with cleft lip and/or palate pre- and post-surgical correction

PURPOSE

Determine the occurrence of dysphagia symptoms in children with cleft lip and/or palate (CLP) pre- and post-surgical correction.

METHODS

Quantitative observational cross-sectional study. Existence of clef lip and/or palate without association with other syndromes was the study inclusion and/or exclusion criterion. Parents and/or legal guardians responded to a recall questionnaire on the identification of occurrence of coughing, choking, vomiting, and nasal escape pre- and postoperatively and whether these symptoms disappeared after surgical correction. The study was approved by the Research Ethics Committee of the aforementioned Institution under protocol no. 1573164.

RESULTS

The sample comprised 23 children with mean age of 48 months, mostly male and with unilateral trans-foramen incisor clefts. Statistically significant difference was observed between the pre- and post-surgical periods regarding the presence of dysphagia symptoms.

CONCLUSION

Surgical treatment of patients with cleft lip and/or palate proved to be a resource to prevent the occurrence of dysphagia symptoms when associated with adequate intervention chronology.

Feeding Infants with Cleft Lip and/or Palate in Brazil: Suggestions to Improve Health Policy and Research

Objective

To verify feeding resources used prior to corrective surgery among cleft babies from Brazil and to discuss suggestions to improve common feeding problems around the world.

Design

Cross-sectional descriptive study conducted at eight medical centers.

Participants

A total of 215 parents or guardians of cleft children.

Methods

Interview based upon a prevalidated questionnaire. The chi-square test and comparison of means by analysis of variance were used; significance level adopted was 5% ( P < .05).

Results

Feeding guidelines were provided in the maternity unit to 53% of the families. Breastfeeding was encouraged among 80% of mothers, predominantly in the South ( P = .016). However, follow-up after maternity discharge was not appropriately carried out and failure to breast-feed occurred in 78% of families. The feeding tube was used in 21%. According to families, for those who used the ordinary nipple, it was considered the best option by the majority (29%).

Conclusion

Neonatal feeding in cleft babies is a global challenge. Reports about the difficulties encountered and successful experiences would be helpful to disseminate strategies and stimulate research directed at the large-scale applicability of neonatal feeding for cleft babies on public health. This study detected the need to increase professional training and emphasizes the need for public policies addressing neonatal referral to specialized care wherever possible. It also stimulates research into using an ordinary nipple as another resource for feeding cleft babies and suggests an international discussion about specific recommendations for humanized primary health care.