A New Angle on Feeding: A Case Report on Elevated Side-Lying to Support Infants With Cleft Palate

Purpose: Infants who were born with cleft lip and/or palate (CL+/−P) often require a specialized feeding intervention due to anatomical differences impacting swallow physiology. The current standard of care for infants with CL+/−P supports an elevated upright feeding position. However, in many populations at increased risk for pediatric dysphagia, elevated side-lying (ESL) has been found to be beneficial in supporting airway protection and feeding efficiency. This case report provides descriptive documentation of two cases where ESL was trialed as part of routine care. The objective of this clinical focus article was to outline the clinical context, concurrent modifications, and practical considerations for trialing ESL positioning for infants with CL+/−P. Method: After institutional review board approval was obtained at two medical centers, a chart review was performed. Information on the patient's chronological age, diagnoses, surgical history, feeding evaluation reports, weights, and relevant clinical notes was obtained. The EQUATOR (Enhancing the QUAlity and Transparency Of Health Research) CARE (CAse REport) reporting guidelines and related evaluative measures were utilized for analysis as both infants underwent treatment from an interdisciplinary team. Results: Two patients with CL+/−P and diagnosed comorbidities demonstrated improved swallow safety in an ESL position, including reduced instances of stress cues, improved swallow safety with a Penetration–Aspiration Scale score of 5 or higher on the videofluoroscopic swallowing study, and an increase in volume intake. Conclusions: Children with CL+/−P require individualized feeding evaluation and intervention, with careful consideration for the patient's comorbid diagnoses. Further research examining the efficacy of ESL positioning for children with CL+/−P is indicated .