To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P).
Design:
Cross-sectional.
Setting:
Pediatric academic medical center in the Midwestern United States.
Participants:
Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments.
Main Outcome Measure(s):
Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained.
Results:
Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems (F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls (F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight (t = 4.13, P = .04) and length (t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration (r = 0.32, P = .01) and lower weight (r = −0.31, P = .02) and length (r = −0.32, P = .02).
Conclusions:
Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.
AbidinRR. Parenting Stress Index Professional Manual. 4th ed. Psychological Assessment Resources; 2012.
2.
American Cleft Palate-Craniofacial Association. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences. Cleft Palate Craniofac J. 2018;55(1):138–156.
3.
ArvedsonJCBrodskyL. Pediatric Swallowing and Feeding: Assessment and Management. 2nd ed. Singular Publishing; 2002.
4.
AvedianLVRubergRL. Impaired weight gain in cleft palate infants. Cleft Palate J. 1980;17(1):24–26.
5.
BradburyETHewisonJ. Early parental adjustment to visible congenital disfigurement. Child Care Health Dev. 1994;20(4):251–266.
6.
ChoeDEMcDonoughSCSameroffAJLawrenceAC. Postnatal trajectories of maternal depressive symptoms: postpartum antecedents and differences in toddler adjustment. Infant Ment Health J. 2020;41(2):278–293. Epub ahead of print https://doi.org/10.1002/imhj.21843
7.
ClarrenSKAndersonBWolfLS. Feeding infants with cleft lip, cleft palate, or cleft lip and palate. Cleft Palate J. 1987;24(3):244–249.
8.
CoxJLHoldenJMSagovskyR.Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150(6):782–786.
9.
Dolger-HafnerMBartschATrimbachGZobelIWittE. Parental reactions following the birth of a cleft child. J Orofac Orthop. 1997;58(2):124–133.
10.
GaffneyKFKitsantasPBritoASwamidossCS. Postpartum depression, infant feeding practices, and infant weight gain at six months of age. J Pediatr Health Care. 2014;28(1):43–50.
11.
GardnerJMGrantham-McGregorSMHimesJChangS. Behaviour and development of stunted and nonstunted Jamaican children. J Child Psychol Psychiatry. 1999;40(5):819–827.
12.
GolfenshteinNHanlonALDeatrickJAMedoff-CooperB.Parenting stress in parents of infants with congenital heart disease and parents of healthy infants: the first year of life. Compr Child Adolesc Nurs. 2017;40(4):294–314.
13.
GottschlichMMMayesTAllgeierCJamesLKhouryJPanBvan AalstJA. A retrospective study identifying breast milk feeding disparities in infants with cleft palate. J Acad Nutr Diet. 2018;118(11):2154–2161.
14.
GreivesMRAndersonCLDeanRAScerboMLDoringoILBebbingtonMWTeichgraeberJF. Survey of parent experiences in prenatal visits for infants with cleft lip and palate. Cleft Palate Craniofac J. 2017;54(6):668–673.
15.
GroteVVikTvon KriesRLuqueVSochaJVerduciECarlierCKoletzkoBEuropean Childhood Obesity Trial Study G. Maternal postnatal depression and child growth: a European cohort study. BMC Pediatr. 2010;10(1):14.
16.
HurleyKMBlackMMPapasMACaulfieldLE. Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants. J Nutr. 2008;138(4):799–805.
17.
JohnsALHershfieldJASeifuNMHaynesKA. Postpartum depression in mothers of infants with cleft lip and/or palate. J Craniofac Surg. 2018;29(4):e354–e358.
18.
JonesWB. Weight gain and feeding in the neonate with cleft: a three-center study. Cleft Palate J. 1988;25(4):379–384.
19.
KayeAThaeteKSnellAChesserCGoldakCHuffH. Initial nutritional assessment of infants with cleft lip and/or palate: interventions and return to birth weight. Cleft Palate Craniofac J. 2017;54(2):127–136.
20.
KingstonDToughSWhitfieldH. Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev. 2012;43(5):683–714.
21.
Lefton-GreifMAOkeloSOWrightJMCollacoJMMcGrath-MorrowSAEakinMN. Impact of children’s feeding/swallowing problems: validation of a new caregiver instrument. Dysphagia. 2014;29(6):671–677.
22.
LindbergNBerglundAL. Mothers’ experiences of feeding babies born with cleft lip and palate. Scand J Caring Sci. 2014;28(1):66–73.
23.
LiuYKaayaSChaiJMcCoyDCSurkanPJBlackMMSutter-DallayALVerdouxHSmith-FawziMC. Maternal depressive symptoms and early childhood cognitive development: a meta-analysis. Psychol Med. 2017;47(4):680–689.
24.
MadhounLLCrerandCEKeimSBaylisAL. Breast milk feeding practices and barriers and supports experienced by mother-infant dyads with cleft lip and/or palate. Cleft Palate Craniofac J. 2020;57(4):477–486.
25.
MaiCTCassellCHMeyerREIsenburgJCanfieldMARickardROlneyRSStallingsEBBeckMHashmiSS, et al.National Birth Defects Prevention N. Birth defects data from population-based birth defects surveillance programs in the United States, 2007 to 2011: highlighting orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(11):895–904.
26.
MarquesILNackashiJABorgoHCMartinelliAPPegoraro-KrookMIWilliamsWNDutkaJCSeagleMBSouzaTVGarlaLA, et al.Longitudinal study of growth of children with unilateral cleft-lip palate from birth to two years of age. Cleft Palate Craniofac J. 2009;46(6):603–609.
27.
MartinVGreatrex-WhiteS. An evaluation of factors influencing feeding in babies with a cleft palate with and without a cleft lip. J Child Health Care. 2014;18(1):72–83.
28.
MasareiAGSellDHabelAMarsMSommerladBCWadeA. The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Cleft Palate Craniofac J. 2007;44(3):321–328.
29.
MizunoKUedaAKaniKKawamuraH. Feeding behaviour of infants with cleft lip and palate. Acta Paediatr. 2002;91(11):1227–1232.
30.
MosseyPAModellB. Epidemiology of oral clefts 2012: an international perspective. Front Oral Biol. 2012;16:1–18.
31.
MurrayLCarothersAD. The validation of the Edinburgh post-natal depression Scale on a community sample. Br J Psychiatry. 1990;157(2):288–290.
32.
OwensJ. Parents’ experiences of feeding a baby with cleft lip and palate. BJM. 2008;16(12):778–784.
33.
PakLAllenPJ. The impact of maternal depression on children with asthma. Pediatr Nurs. 2012;38(1):11–19.
34.
ParkerSEMaiCTCanfieldMARickardRWangYMeyerREAndersonPMasonCACollinsJSKirbyRS, et al.National Birth Defects Prevention Network. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol. 2010;88(12):1008–1016.
35.
PopeAWTillmanKSnyderHT. Parenting stress in infancy and psychosocial adjustment in toddlerhood: a longitudinal study of children with craniofacial anomalies. Cleft Palate Craniofac J. 2005;42(5):556–559.
36.
ReidJKilpatrickNReillyS. A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions. Cleft Palate Craniofac J. 2006;43(6):702–709.
37.
ReidJReillySKilpatrickN. Sucking performance of babies with cleft conditions. Cleft Palate Craniofac J. 2007;44(3):312–320.
38.
SethAKMcWilliamsBJ. Weight gain in children with cleft palate from birth to two years. Cleft Palate J. 1988;25(2):146–150.
39.
SpeltzMLArmsdenGCClarrenSS. Effects of craniofacial birth defects on maternal functioning postinfancy. J Pediatr Psychol. 1990;15(2):177–196.
40.
StewartRC. Maternal depression and infant growth: a review of recent evidence. Matern Child Nutr. 2007;3(2):94–107.
41.
StockNMCostaBWhitePRumseyN. Risk and protective factors for psychological distress in families following a diagnosis of cleft lip and/or palate. Cleft Palate Craniofac J. 2020;57(1):88–98.
42.
StollCAlembikYDottBRothMP. Associated malformations in cases with oral clefts. Cleft Palate Craniofac J. 2000;37(1):41–47.
43.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. World Health Organization; 2006.
44.
WisnerKLParryBLPiontekCM. Clinical practice. Postpartum depression. N Engl J Med. 2002;347(3):194–199.
45.
WongFKHaggU. An update on the aetiology of orofacial clefts. Hong Kong Med J. 2004;10(5):331–336.
46.
WrightCMParkinsonKNDrewettRF. The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort. Arch Dis Child. 2006;91(4):312–317.
47.
Yagci-KupeliBAkyuzCKupeliSBuyukpamukcuM. Health-related quality of life in pediatric cancer survivors: a multifactorial assessment including parental factors. J Pediatr Hematol Oncol. 2012;34(3):194–199.
