As with any newborn, the primary concerns in the neonatal period are airway maintenance, breathing, and feeding. Some of the anatomic variations in children with clefts and craniofacial anomalies may have an impact on these functions.

1. Airway maintenance
   1. Cleft lip and/or cleft palate rarely cause problems with the upper airway or breathing, when there are no other associated problems.
   2. Pierre-Robin Sequence is the most common anatomic deviation associated with clefting that can result in airway and breathing problems.
      1. Pierre-Robin Sequence results in a combination of malformations, consisting of mandibular hypoplasia, glossoptosis, and midline cleft of the secondary palate.
      2. Usually airway problems can be managed with prone positioning and time for growth to occur. However, dental prosthetic or surgical intervention, including tracheostomy, may be required in severe cases. In addition, distraction osteogenesis of the mandible has been used to treat some infants with severe airway problems due to Pierre Robin Sequence, but its use at this age is controversial.
   3. Craniofacial anomalies can also be associated with airway problems. These include, but are not limited, to:
      1. Syndromal craniosynostosis with severe midface hypoplasia.
      2. Any syndrome associated with a severely deficient mandible, such as severe Treacher-Collins Syndrome.
      3. Choanal atresia.
2. Feeding and Nutrition
   1. Babies with isolated clefts of the lip and/or palate can usually feed by mouth with some adjustments to bottle-feeding techniques. Tube feeding is rarely required.
   2. Babies with isolated cleft lip may be able to breast feed, but it is unlikely that a child with a cleft palate will be able to successfully breast feed because of nasal spillage and the difficulty in maintaining an adequate suction.
   3. Despite the problems with maintaining sucking pressures, the swallowing mechanisms in children with cleft palate are usually normal. Therefore, if the milk or formula can reach the oropharynx, the natural swallowing reflexes can move it into the esophagus.
   4. Some nasal regurgitation may occur, but this is rarely more than an inconvenience. Upright positioning during feeding may help reduce the occurrence of nasal regurgitation.
   5. The strategies that have been developed to feed infants with clefts of the palate are designed to overcome the lack of negative pressure developed during sucking. These include, but are not limited, to:
      1. Cross-cutting fissured nipples.
      2. Squeezing a soft bottle to help with the flow of milk.
      3. Pumping the breasts to deliver breast milk via bottle.
      4. Developing patience in feeding.
      5. Feeding instruction and follow-up with a feeding specialist on the cleft palate team.
   6. It is important to ensure that the energy that a child expends during feeding does not exceed the nutritional and caloric intake from the feeding. This problem may occur if feeding takes more than 30 minutes.
   7. Steady weight gain is the most important indicator of adequate food intake. Close follow-up with a pediatrician or other health care provider is necessary to ensure that consistent weight gain is achieved.
   8. Frequently, airway problems will be exacerbated during feeding. The combination of the inability to maintain adequate sucking and airway problems may lead to the need for an alternative feeding method.
   9. These same principles apply to babies with other craniofacial anomalies, even though the anatomic cause of their feeding problems may be mandibular or maxillary hypoplasia, rather than clefting.

Footer

©2007 American Cleft Palate-Craniofacial Association

website by Kilpatrick Design Studio