Survey of Barriers to Breast Milk Feeding in Children With Cleft Palate

Objective Explore barriers and prioritize supports that could increase breast milk feeding (BMF) rates. Design Survey study. Setting Tertiary children's hospital. Patients, Participants 204 mothers [102 with child with cleft palate (CP), 102 with child with intact palate], ages 0-3 years old. Interventions Survey questions about older sibling feeding history, maternal education, and breastfeeding/breast milk pumping experience. Main Outcome Measure(s) Differences in survey responses between groups; associations between socioeconomic (SES) proxies and BMF. Results Median child age at survey completion was 17.7 months (range 9 days-3.9 years). Direct breastfeeding was less common in the group with CP (46.1% vs. 73.5%, P < .001), who were also more frequently advised against breastfeeding (34.0% vs. 10.9%, P < .001) and more often formula fed (94.1% vs. 85.3%, P = .04). Despite this, the control and CP groups had equal initiation of BMF (77.5%), with no significant difference in median duration (1.0 vs. 1.5 months). Sustained BMF to 6 months was seen in 23.1% of CP group and 28.9% of controls. In the CP group, postnatal counseling (odds ratio [OR] 21.8, P < .001), receiving a breast pump (OR 40.8, P < .001), family support (OR 7.44, P < .001), prior experience with BMF (OR 11.4, P < .001), and maternal education (OR 4.30, P = .006) increased the odds of BMF. Proxies of higher SES were associated with longer BMF in the CP group but not controls (all P < .02). Conclusions Targeted supports for mothers of children with CP such as integrating early feeding specialists and education on pump retrieval are vital to decrease the barriers to sustained BMF.