IN BRIEF

Improving Feeding and Growth in Children With Cleft Palate

May 29, 2018
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Targeted interventions result in improved feeding efficiency and growth in infants with cleft lip and/or palate.

Cleft lip and/or palate is a relatively common birth defect that occurs when certain parts of the face and mouth fail to fuse during development. Infants with the condition can struggle to suck or extract liquid from the breast or bottle and end up expending more energy attempting to feed than they take in, placing them at risk for failure to thrive.

About two years ago, the Cleft Lip and Palate Center at Nationwide Children’s Hospital had a baseline of 17 percent of infants with cleft lip and/or palate being diagnosed with failure to thrive each month.

“We had the opportunity to do more to address the feeding and growth needs of these infants,” says Adriane Baylis, PhD, CCC-SLP, a speech-language pathologist, clinical researcher, and director of the Velopharyngeal Dysfunction Program at Nationwide Children’s.

Dr. Baylis and her colleagues established and implemented a systematic, comprehensive, evidence-based approach to feeding services within the Cleft Lip and Palate Center, which now consists of an interdisciplinary team of medical specialists, feeding therapists, and social workers. They reported the results in The Cleft Palate-Craniofacial Journal in March.

Baylis and her colleagues formed a team, which included nurses, feeding therapists (speech-language pathologists and occupational therapists with expertise in feeding), nurse practitioners, social workers, plastic surgeons, and parents of clinic patients, with the goal of improving feeding and growth outcomes and reducing the rate of failure to thrive.

The team identified three key themes around which they designed interventions: (1) caregiver education and resources, (2) care coordination and flow and (3) provider education and training.

Some of the interventions were created for families experiencing psychosocial challenges in mind. The team noticed that many babies who were not feeding or growing well had families with economic or transportation challenges, prenatal drug/alcohol exposure or barriers to understanding complex feeding instructions.

“We wanted to create an approach that blended the medical and psychosocial needs of our patients and their families,” says Dr. Baylis, who is also an assistant professor of Plastic Surgery and Pediatrics at The Ohio State University. “We enhanced our medical interventions for feeding, but we also provided more support to families so they could access the resources they needed.”

This included social work assessments for all new families and the initiation of a patient tracking system to ensure infants were not lost to follow-up.

Approximately two years after initiating the project, Dr. Baylis and her team have seen the rate of failure to thrive diagnoses drop from 17 to 7 percent and the frequency of hospitalizations decrease from one every 30 days to one every 118 days. Additionally, no patients have been lost to follow-up.

“We were very happy to see these positive changes result from interventions that were practical and not costly,” says Dr. Baylis. “The interventions involved better communication and better utilization of resources we already had at hand.”

The results show that targeted interventions aimed at improving feeding, combined with changes in care delivery models, can help infants with cleft lip and/or palate feed and grow. Healthier, well-nourished babies may undergo surgical repair of the cleft earlier and have better outcomes.

Dr. Baylis says these interventions can be adapted and implemented in similar institutions to achieve improvements like the ones at Nationwide Children’s. She has received feedback from other cleft teams around the country that are now following this model and implementing a similar team-based approach to feeding and growth in their patients with cleft lip and/or palate.

“This initiative has been great for us here at Nationwide Children’s because we have a much deeper sense of collaboration across the different units,” Dr. Baylis says. “We see ourselves as part of a much larger team than when we started this project.”

 

Reference:

Baylis AL Pearson GD, Hall C, Madhoun LL, Cummings C, Neal N, Smith A, Eastman K, Stocker C, Kirschner RE. A quality improvement initiative to improve feeding and growth of infants with cleft lip and/or palate. The Cleft Palate-Craniofacial Journal. 2018 Mar 28. [Epub ahead of print]