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

ObjectiveExplore barriers and prioritize supports that could increase breast milk feeding (BMF) rates.DesignSurvey study.SettingTertiary children's hospital.Patients, Participants204 mothers [102 with child with cleft palate (CP), 102 with child with intact palate], ages 0-3 years old.InterventionsSurvey 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.ResultsMedian 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%, <i>P</i> < .001), who were also more frequently advised against breastfeeding (34.0% vs. 10.9%, <i>P</i> < .001) and more often formula fed (94.1% vs. 85.3%, <i>P</i> = .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, <i>P</i> < .001), receiving a breast pump (OR 40.8, <i>P</i> < .001), family support (OR 7.44, <i>P</i> < .001), prior experience with BMF (OR 11.4, <i>P</i> < .001), and maternal education (OR 4.30, <i>P</i> = .006) increased the odds of BMF. Proxies of higher SES were associated with longer BMF in the CP group but not controls (all <i>P</i> < .02).ConclusionsTargeted 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.