Assisted feeding is more reliable for infants with clefts - A randomized trial

Objective: To compare the effectiveness of squeezable and rigid feeding bot tles for infants with clefts. Design: Patients were randomly assigned at birth to feeding with a squeezab le bottle (assisted feeding) or to feeding with a rigid bottle and were fol lowed for 1 year, The data were analyzed on the basis of intention to treat . Setting: The trial was conducted within the existing arrangements for hospi tal and home care for children with clefts within the National Health Servi ce in the north of England. Patients: The patients were 101 consecutively born children with cleft lip and/or palate who were otherwise healthy, All patients completed the trial, Two were excluded from the analysis when unrelated developmental problems became apparent. Main outcome measures: Anthropometric measures-nude weight, crown-heel leng th (CHL), and occipito-frontal circumference (OFC)-were recorded. Results: There were statistically significant differences between the two g roups in weight at 12 months (p =.038, with an adjusted mean difference of 0.43 kg) and in head circumference (p =.004 with an adjusted mean differenc e of 0.77 cm), indicating increased growth in the squeezable bottle group. The difference in CHL was not significant at conventional levels (p =.082), Whereas 25 of 52 (48%) rigid bottles required modification by the health v isitor, this was needed for only 4 of 49 (8%) squeezable bottles, There was a highly significant difference when numbers of modifications for each met hod were compared (p <.0001), Despite modifications, six infants feeding wi th a rigid bottle (11%) were transferred to a squeezable bottle due to prob lems with feeding, but none were transferred from squeezable to rigid bottl es, Thus, the squeezable bottle generally appeared to be a more satisfactor y method, requiring less support or intervention after initial instruction. Conclusions: Both feeding methods achieved similar anthropometric outcomes, with a beneficial effect on head circumference and weight in the assisted feeding group. We recommend that this last observation be treated with caut ion. The squeezable bottles were easier to use, and we recommend that they be routinely prescribed.