Assisted Feeding is More Reliable for Infants with Clefts—A Randomized Trial

Objective To compare the effectiveness of squeezable and rigid feeding bottles for infants with clefts. Design Patients were randomly assigned at birth to feeding with a squeezable bottle (assisted feeding) or to feeding with a rigid bottle and were followed for 1 year. The data were analyzed on the basis of intention to treat. Setting The trial was conducted within the existing arrangements for hospital and home care for children with clefts within the National Health Service 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 length (CHL), and occipito-frontal circumference (OFC)—were recorded. Results There were statistically significant differences between the two groups 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 difference 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 visitor, this was needed for only 4 of 49 (8%) squeezable bottles. There was a highly significant difference when numbers of modifications for each method were compared (p < .0001). Despite modifications, six infants feeding with a rigid bottle (11%) were transferred to a squeezable bottle due to problems with feeding, but none were transferred from squeezable to rigid bottles. Thus, the squeezable bottle generally appeared to be a more satisfactory 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 caution. The squeezable bottles were easier to use, and we recommend that they be routinely prescribed.