Parental Perspectives of Children Born With Cleft Lip and/or Palate: A Qualitative Assessment of Suggestions for Healthcare Improvements and Interventions

Attributes That Increase Vulnerabilities to Reduced Human Milk Feeding Outcomes Among Babies With Cleft Lip and Palate in the Neonatal Intensive Care Unit

OBJECTIVE

The purpose of this study was to identify infant and maternal factors associated with reduced human milk feeding among infants in a neonatal intensive care unit (NICU) with cleft lip with or without cleft palate (CL ± P).

METHOD

Data collected on mothers and infants admitted to the NICU with CL ± P from the 2018 National Vital Statistics System were used for this study. Chi-square tests of independence and independent-samples t tests were used to compare categorical variables and continuous variables, respectively, among two groups of infants admitted to the NICU with CL ± P-those who did and did not receive human milk feeding at discharge.

RESULTS

The sample included 660 infants admitted to the NICU with CL ± P, of which 353 received human milk at discharge. Significant differences were found between the two groups for marital status, mother's education, maternal smoking record, total number of prenatal visits, multiparity record, gestational age, birth weight, and use of assisted ventilation.

CONCLUSIONS

Results indicated that, as a function of human milk feeding at discharge, mothers and their infants admitted to the NICU with CL ± P exhibited differences across infant and maternal factors. These findings further our understanding of this sample of mothers and infants with CL ± P while potentially identifying determinants to human milk feeding. This study provides insight into infant and maternal characteristics that may be associated with barriers to human milk feeding.

Persistence, strength, isolation, and trauma: An ethnographic exploration of raising children with cleft palate

BACKGROUND

The lives of families of young children with cleft palate (±lip) are complex. Multiple interventions are required as part of the long-term multidisciplinary treatment for children with CP±L, with an impairment-focused approach prevailing. Research with young children with CP±L has focused on treatment and intervention, and previous qualitative research has been collected predominantly via interviews, so little is understood about the day-to-day lives of families of young children with CP±L.

AIMS

(1) To increase understanding of the lives of children with CP±L and their families by applying an ethnographic lens to improve clinical practice (2) to identify key interactions and encounters that shape the experiences of children with CP±L and their families (3) to examine how family-centered practice can enhance practitioner-family relationships in providing effective and evidence-based care for children with CP±L.

METHOD

Ethnographic observations of seven families of children with CP±L and their families and educators including parents, siblings, aunts, grandparents, and teachers involved multiple site visits. Rich data were collected to gather information about different aspects of their lives (such as their strengths, routines, preferences, challenges and experiences). There were 84 artefacts collected: 18 interviews, 29 videos, one extended audio recording of a mealtime, seven photos contributed by families, seven case history questionnaires, and 22 field notes. These data were analyzed inductively using thematic analysis.

RESULTS

Three overarching themes and 11 subthemes were identified: (1) the whole child (persistence, communication, activities, mealtimes), (2) family strength and support (strong families, external support, attitudes, advocacy, positive medical experiences) and (3) family isolation and trauma (negative medical experiences, traumatic and challenging experiences).

CONCLUSION

This is the first study to use ethnographic methodology to facilitate the collection of unique insights into the lives of young children with CP±L and their families to improve clinical practice for SLPs. The unique application of family-centered practice with these families promoted trust and highlighted their challenges and strengths which could be considered by SLPs to provide holistic intervention.

A Retrospective Study Identifying Breast Milk Feeding Disparities in Infants with Cleft Palate

BACKGROUND

Breast milk represents the optimal substrate for all infants, including those with a cleft palate for whom growth may be compromised.

OBJECTIVES

Frequency of breast milk feeding at the breast and per feeder (bottle, cup, enteral tube) in infants with cleft palate was determined and compared with rates reported by the Centers for Disease Control and Prevention. A secondary aim was to review growth status of the infants.

DESIGN

This study represents a 5-year retrospective review using the electronic medical record.

PARTICIPANTS AND SETTING

Patients were ≤12 months old at the time of the initial, presurgical encounter after a diagnosis of cleft palate had been made and were treated at one of two pediatric cleft palate and craniofacial centers in Ohio between September 30, 2010, and September 30, 2015.

MAIN OUTCOME MEASURES

Outcomes measured were breast milk use, reported by mothers and documented in patients' electronic medical records, chronological body weight, as well as weight for length and weight-for-age z scores and percentiles.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics included median with interquartile range and frequency with percentages. World Health Organization z scores were estimated using the Centers for Disease Control and Prevention programs for weight, weight for length, and weight for age at first visit. Comparisons of infants treated at the two hospitals were done using the Wilcoxon rank-sum test or the χ² test.

RESULTS

Breast milk consumption (26 infants were breastfed and 84 received human breast milk administered with a device) was 29.5%, markedly below the 2016 Centers for Disease Control and Prevention national statistics for ever receiving breast milk (81%). Anthropometric findings included z scores of -0.95 and -0.42 for weight for age and weight for length, respectively.

CONCLUSIONS

Infants with cleft palate were seldom breastfed, nor was breast milk frequently used. In addition, median weight-for-age and weight-for-length z scores suggest that growth of infants with cleft palate was below normative standards.

Assessment and Management of Psychosocial Needs: Social Work Utilization in Comprehensive Cleft Team Care

OBJECTIVE

To determine family-reported psychosocial stressors and social worker assessments and interventions within a comprehensive cleft team.

DESIGN

Single-institution prospective provider-completed survey.

PATIENTS

Four hundred one families seen by cleft team social worker over a 7-month period.

RESULTS

Most families (n = 331; 83%) participated in the team social work assessment. At least 1 active psychosocial stressor was reported by 238 (72%) families, with 63 (19%) families reported 3 or more stressors. There were 34 types of stressors reported. Most common were financial strain, young age of patient, new cleft diagnosis, and distance from clinic (57% of families live over an hour away). Family structure and home environment were assessed in detail for 288 (87%) families. Detailed assessments for access to care and behavioral/developmental issues also figured prominently. Social work interventions were provided in 264 (80%) of the visits, of which 91 were for families of new patients with over half who had infants less than 3 months old. Of the 643 interventions provided, the most frequent were parent mental health screens and counseling, early intervention referrals, transportation assistance, securing local hotel discounts, orthodontic referrals, and orthodontic cost coverage. Approximately 10% of encounters required follow-up contact related to the psychosocial concerns identified in clinic.

CONCLUSIONS

The inclusion of a cleft team social worker is a critical component of comprehensive cleft team care as evidenced by the large proportion of families who required assistance. Ongoing social work assessments are recommended for each patient to help address the variety of psychosocial stressors families face.