Submucous cleft palate in the differential diagnosis of feeding difficulties

Article Abstract:

Feeding difficulties in newborns have not been well-studied. There are many reasons why newborns may feed slowly. One cause that is often overlooked is submucous cleft palate, the abnormal attachment of the muscles in the palate. Submucous cleft palate can lead to feeding difficulties, speech problems, and middle ear disease. Since the oral and nasal soft tissue can appear intact, this condition is easily overlooked. The diagnosis can be made if three symptoms are present: an uvula (the small process hanging in the back of the soft palate) that appears to be split; a translucent line down the center of the soft palate; and an absent or notched nasal spine. In some cases, submucous cleft palate accompanies a cleft lip. These three signs can also be missing, making diagnosis more difficult. The adenoids are often removed in children with recurrent ear infections. However, if recurrent ear infections are caused by submucous cleft palate, surgical removal of the adenoids does not alleviate the problem. The experience of 81 patients with submucous cleft palate over a 15-year period is reported. There were 26 patients available for interview. Children under the age of two and one half were referred for feeding problems, and older children (to 10 years old) were referred by speech therapists. All of the children over the age of 10 had speech problems, with most having a history of poor feeding as a baby. Overall, 39 had problems with feeding. In the group available for interview, 22 had a history of slow feeding and nasal regurgitation (fluid leaving the nose during peaceful feeding). Children who take longer than 40 minutes to feed (normally it takes between 4 and 23 minutes), who also have nasal regurgitation, should be evaluated for submucous cleft palate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Causes of, Otitis media, Ingestion disorders, Sucking behavior, Speech disorders

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Cleft lip - is there light at the end of the tunnel?

Article Abstract:

Cleft lip, with or without cleft palate (CL/P), is one of the most common head and facial birth defects. It is estimated to occur in 1 of every 700 to 1,000 live births. CL/P can be repaired by plastic surgery, but it may require several operations during childhood and adolescence. At 18 weeks of pregnancy ultrasound can be used to diagnose this condition. In most cases, however, it is not severe enough to justify terminating the pregnancy. Couples who have a family history of CL/P have a greater risk of having a baby with this condition. The risk of having a second baby with CL/P is 1 in 25 for couples with a family history of CL/P and 1 in 1,000 for couples with no family history of CL/P. Genetic counseling has proven to be less than satisfactory as it can only give an estimate of the risk of having a second child with CL/P. The exact genetic abnormality that causes CL/P has not been identified. In families with a common history of this condition, CL/P may be inherited as an autosomal dominant trait (that is, caused by inheriting one affected chromosome). Based on recent studies that have attempted to locate the genetic abnormality responsible for CL/P, abnormalities in the short arm of chromosome six have been implicated. However, it is likely that a number of different genes and environmental factors, such as treatment of pregnant women with phenytoin (Dilantin) for epilepsy, are involved in causing CL/P. (Consumer Summary produced by Reliance Medical Information, Inc.)

Genetic aspects, Cleft lip

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Caesarean section and duration of breast feeding among Brazilians

Article Abstract:

Brazil may have the highest incidence of caesarean sections in the world. Between 1981 and 1986, almost 32 percent of the babies born in Brazil, and 43.2 percent of the babies born in Rio de Janeiro and Sao Paulo were delivered by caesarean section. It has been suggested that mothers who deliver by caesarean section may not breast feed their infants, a fact that may have detrimental effects on the infant's health. A recent study of 4,912 Brazilian infants revealed that the duration of breast feeding for infants born vaginally was the same as that for babies delivered by caesarean section. In contrast, infants born by emergency caesarean section were more likely to be separated from their mothers and were breast fed for a shorter period of time than infants delivered by a planned caesarean section or vaginally. These findings are in contrast to earlier results which reported that caesarean delivered infants were breast fed for a shorter period of time than vaginally delivered infants. Differences observed in these studies may be due to the methods used for obtaining data. In addition, the current findings indicate that immediate contact between mother and child may not be as important as previously thought for the successful establishment of breast feeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Physiological aspects, Demographic aspects, Brazil, Breast feeding, Cesarean section

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