Nutrition in Infants with Orofacial Clefts: An Assessment of Feeding Practices and Factors Affecting Feeding

Abstract

Background and Aim: Orofacial clefts are congenital anomalies that pose significant challenges to infant feeding, particularly in resource-limited settings. These feeding difficulties can compromise nutritional status, increase reliance on breastmilk substitutes (BMS), and contribute to undernutrition. This study assessed feeding practices and nutritional challenges in infants with orofacial clefts in Kano, Nigeria. Methods: A descriptive cross-sectional study conducted at the Cleft Clinic of the Armed Forces Specialist Hospital, Kano. Data were collected from 100 mother-infant dyads using an interviewer-administered questionnaire. Feeding methods, maternal counseling, exclusive breastfeeding (EBF) rates, BMS usage, and nutritional status were evaluated. Anthropometric measurements were taken, and infant nutritional status was categorized using World Health Organisation growth standards. Statistical analysis was performed to determine associations between feeding practices and nutritional outcomes. Data was analysed using the R statistical software. Results: Breastfeeding initiation was high (94%), but EBF was practiced by only 2% of mothers. BMS were introduced early, at a median age of 2 days, predominantly as commercial infant formula. Syringe feeding was the predominant method (86%), while specialized feeding bottles were absent. Undernutrition was prevalent, with 46% of infants classified as wasted and 48% underweight. Wasting increased with infant age and was significantly associated with early BMS introduction (P = 0.041), maternal undernutrition (P = 0.003), and higher socioeconomic class (P = 0.031). Infants who received BMS had five-fold higher odds of wasting (OR 5.01. 95% CI 1.17 – 21.49), while infants of overweight mothers had significantly reduced odds. Feeding challenges were widespread, mainly poor latch, nasal regurgitation, and limited maternal knowledge of cleft-specific feeding techniques. Conclusions: Infants with orofacial clefts in Kano experience profound early feeding difficulties, extremely low exclusive breastfeeding rates, and a high burden of undernutrition. Integrating targeted nutritional counselling and cleft-specific feeding support into routine cleft care is urgently needed to improve early growth outcomes.