Smile Train: Adequate nutrition prevents malnutrition in children with cleft lip and palate

By Adeleye Kunle

Children born with cleft lip and/or palate face a lot of social rejection in low-income countries like Nigeria. This stigma places them at a disadvantage in education, employment, marriage, and community, and it is exacerbated by barriers to care.

However, nutrition experts from Smile Train believe that nutrition is critical to saving these children because they will be born with feeding difficulties due to the anatomy of having a cleft or a palate.

Cleft lip and palate are facial and oral malformations that develop very early in pregnancy, while the baby is still developing inside the mother.

According to Miriam Nabie, a Clinical Nutritionist and Smile Train Nutrition Advisor, many children born with cleft and palate are exposed to malnutrition, which often leads to death or prevents them from receiving early life-saving surgical intervention.

Nabie, the facilitator of a 5-day workshop for nutritionists, dieticians, and nurses from Smile Train partner hospitals in Nigeria, expressed concern that many mothers are unable to feed their children due to a lack of information.

She explained that if breastfeeding and other forms of feeding are delayed, the baby may be exposed to malnutrition because lactation may no longer be possible in the mother.

“Our Smile Train surgery requires a minimum age of three months for cleft lip and one year for cleft palate.” So nutrition is critical in order to avoid delaying or postponing the child’s surgery, as we may lose some of these children due to malnutrition. And it has been reported that the majority of these children are being lost because no one knows how to feed them.”

She explained that because a child with a cleft lip/palate cannot latch to the breast to suck milk, mothers are taught different breastfeeding positions than a typical child, thus the need for the Smile Train workshop.

“The first option would be for the mother to express her milk in the appropriate steps and give her child the milk using special cups for children with cleft lip called nifty cups or we use specialised bottles which may not be easily accessible here in Nigeria and are quite expensive,” Nabie, who works with Tofem Dreamland Mission Hospital in Kenya, said.

“If a mother is unable to breastfeed due to a delay, the next option would be commercial infant formulas with all hygiene parameters in place.”

She explained that the training focused on supporting comprehensive cleft care through nutrition and feeding, and that it empowered healthcare providers to incorporate nutrition into their department so that they can support and promote breastfeeding for children with cleft lip and palate once they arrive at the hospital on time.

Mrs Victoria Awazie, Senior Programme Manager for Smile Train West Africa, explained that the nutrition training program for nutritionists working in their partner hospitals was designed to ensure that these nutritionists provide treatment to malnourished cleft patients and prevent children born with cleft lip and cleft palate from dying of malnutrition.

She stated that Smile Train research has revealed that one of the most common problems these children face is malnutrition because their mothers do not know how to feed them when they are born.

As a result of this training, nutritionists and dieticians will be able to train the mothers of these children.

“The link between nutrition and these conditions is that when the child is born, he or she is underweight, and because of the cleft lip and palate, the baby finds it difficult to suck, so the mother will be educated on how to extract breast milk to feed the baby, and there is a position the child will be positioned on the breast to latch on to the breast.” So if the mother doesn’t have that knowledge, she won’t be able to feed the child, and again, many of them don’t eat well because of their condition, so they won’t gain the weight needed for the surgery, so the child needs to be nutritionally built up to be able to have the adequate weight for the surgery.”

Awazie stated that 15 participants from Lagos State University Teaching Hospital, University of Port Harcourt Teaching Hospital, Metro Consultant, Gombe, Galaxy Eastern Foundation, Imo, National Orthopaedic Hospital, Enugu, Edinma’s Specialist Hospital, Anambra, Sambo Hospital, and Noma Hospital Sokoto are being trained.

Ann Ozoh, a participant who is also a Chief Dietician at the University College Hospital in Ibadan, acknowledged that the training was impactful and eye-opening, stating that they were exposed to areas such as cleft management, the importance of breastfeeding, and steps to ensure that babies born with cleft and palate are breastfed. “I learned about growth, growth monitoring in standard patterns, plotting it, and then ensuring that my patient has a healthy nutritional status.” I learned about the various feeding stages and breastfeeding positions for babies.

Recognizing that cleft lip and palate is a major issue in Nigeria, Ozoh stated that about 5 new cases of cleft lip and palate are seen at her center each visit, with more than 20 new cases seen in a month.

According to Smile Train, adequate nutrition prevents malnutrition in children with cleft lip and palate.