Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate

Cleft lip and cleft palate (the roof of the mouth) are common defects. The severity of the cleft (opening) varies and it can occur on one (unilateral) or both sides (bilateral). It can be difficult to feed babies enough nutritious food when they have this condition, and there is evidence of delayed development in children born with cleft.

This review aimed to compare the effects of different feeding interventions such as maternal advice and support, modified bottles and/or teats, obturating or maxillary plates (plates placed in the roof of the mouth to artificially close the cleft palate) and supplemental breastfeeding in babies with cleft lip and/or palate prior to, or following, closure. Interventions in the first 6 months from term and used with breast milk or formula feeding only were considered, but outcomes (measures of growth, development and parental satisfaction) may have been measured at any time including adulthood.

Maternal advice and support on feeding techniques and breastfeeding positions are often provided, but no studies evaluated the effectiveness of this intervention. Squeezable rather than rigid bottles may be easier to use for feeding babies with cleft lip and/or palate, and breastfeeding may have growth advantages over spoon-feeding following cleft lip surgery. Only five studies (including 292 babies) compared the effects of feeding interventions in babies with cleft lip and/or palate on growth, development or parental satisfaction. Evidence for breastfeeding rather than spoon-feeding following surgery was weak and there was a suggestion that squeezable bottles may be more manageable than rigid ones. No evidence was found to support the use of maxillary plates in babies with unilateral clefts and no studies assessed the effects of maternal advice or support. Further research is required to assess the most effective feeding interventions to prevent developmental delays in infants with cleft lip and/or palate.

Authors' conclusions: 

Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that breastfeeding is better than spoon-feeding following surgery for cleft. There was no evidence to suggest that maxillary plates assist growth in babies with clefts of the palate. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.

Read the full abstract...

Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts.


This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction.

Search strategy: 

The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 27 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 27 October 2010), EMBASE via OVID (1980 to 27 October 2010), PsycINFO via OVID (1950 to 27 October 2010) and CINAHL via EBSCO (1980 to 27 October 2010). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication.

Selection criteria: 

Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term).

Data collection and analysis: 

Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible.

Main results: 

Five RCTs with a total of 292 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (two studies). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No difference was shown for infants fitted with a maxillary plate compared to no plate. However, there was some evidence of an effect on weight at 6 weeks post-surgery in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% confidence interval 0.20 to 0.74).