While nutrition is important for all infants, babies with clefts are uniquely vulnerable to malnutrition, even when food supply is abundant. Because cleft conditions make it challenging to eat, children with these conditions are predisposed to growth stunting and being underweight
Despite significant progress achieved through policy-level interventions in recent decades, India still grapples with a formidable developmental challenge in the form of malnutrition. The most recent findings from NFHS 5 reveal that 32.1 per cent of children under the age of five in India are underweight, 35.5 per cent are stunted, and 19.3 per cent are wasted. To tackle this issue head-on, nutrition has assumed a prominent role in national initiatives, with India's Prime Minister officially designating September as Rashtriya Poshan Maah (National Nutrition Month). This month-long campaign is dedicated to increasing awareness about nutrition and providing vital support to children, pregnant women, and lactating mothers, with the overarching goal of eliminating malnutrition from the country. To ensure active involvement at the grassroots level, the government also encourages active participation of non-profit organisations to maximise the desired outcomes.
While malnutrition has an adverse effect on anybody suffering from it, children born with congenital health conditions like cleft lip and palate experience more severe adverse effects as malnutrition in them not only disrupts the natural growth pattern and overall well-being but also delays their essential cleft surgery process making them vulnerable to several infections and other health complications. According to estimates by the World Health Organization (WHO), approximately 35,000 babies are born with cleft lip and palate in India annually. A cleft condition not only impact a child's appearance but can also lead to significant health challenges, including difficulties in eating, breathing, hearing, and speaking.
While nutrition is important for all infants, babies with clefts are uniquely vulnerable to malnutrition, even when food supply is abundant. Because cleft conditions make it challenging to eat, children with these conditions are predisposed to growth stunting and being underweight. This is because clefts affect their ability to suck, often making it very difficult to breast- or bottle-feed, it is common for them to regurgitate food through their nose and mouth when nursing. Without support, many babies with clefts will face irreversible effects or even die from malnutrition.
Although there is no national survey report available on this, but independent data collected by organisations like Smile Train (world’s largest cleft focused NGO) suggests that 20-30 per cent children born with cleft lip and palate are unable to receive timely surgery due to malnutrition. According to the recently released IHME and Smile Train global report “Malnourished babies and children are also at increased risk of complications from anaesthesia and surgery and are known to heal less quickly. It’s critical that babies meet a minimum safe standard of weight and height before they have cleft surgery. Delayed surgery can accelerate feeding challenges and the risk of malnutrition, lead to delayed speech development, and permanently impact a baby’s overall health and development.”
Proper nutrition management is essential for these children to thrive. Early diagnosis, breastfeeding support, and guidance during complementary feeding are crucial components of managing cleft lip and palate related nutritional challenges.
Early Diagnosis and Intervention: The identification of a cleft lip and palate condition during ultrasound necessitates the initiation of counselling for the mother at that very moment. The doctor should initiate discussions about caring for the newborn's health and meeting their nutritional requirements, as this plays a pivotal role in ensuring the child's survival and subsequent timely cleft surgery.
Breastfeeding Support: Infants born with clefts face critical feeding challenges. They tend to swallow too much air, get exhausted while feeding, may discharge milk from the nose, choke due to milk going into the airway etc. Mothers should be provided with specialised guidance on breastfeeding techniques by the medical staff at the hospital.
Complementary Feeding Guidance: As children transition to solid foods, speech therapists and nutritionists can provide guidance on modified textures and feeding techniques. Soft, easily digestible foods can be introduced gradually to prevent choking and aspiration.
Emotional Support: Caring for a child with a cleft can be emotionally draining for parents. Providing emotional support and counselling services can help parents cope with the stress and anxiety associated with the condition.
Community Awareness: Raising awareness about cleft lip and palate within communities is essential to reduce stigma and encourage early intervention. Community health workers can play a vital role in educating families about the treatment available and encourage them to seek medical support.
(Mamta Carroll is Senior Vice President and Regional Director for Asia, Smile Train. )