Examining Milk-Thickening Practices for Infants With Cleft Palate: A Scoping Review

Purpose: A common intervention to address aspiration and reflux in infants is thickening milk. However, thickening milk may further complicate feeding man-agement for infants with cleft palate using adaptive feeding methods. The pur-pose of this scoping review was to identify and describe the types of milk thick-ener used for infants with cleft palate (with or without cleft lip) and the feeding modalities through which thickened milk is administered. Method: A comprehensive scoping review was conducted following the Pre-ferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Five databases were searched: PubMed, Scopus, CINAHL, Google Scholar, and EBSCO Open Dissertations, in addition to citation searching. Records were limited to English-language publications with no date restrictions. Both peer-reviewed and gray-literature sources were included. After removing 868 duplicates, 2,282 records were screened by title and abstract. Sixty-four full-text articles were assessed for eligibility. Results: One study met the inclusion criteria. Milk thickening was used as an intervention for infants with isolated Pierre Robin sequence and cleft palate. The thickener used was a modified corn-based flour at approximately 3% concen-tration to achieve a thicker liquid consistency. The thickened milk was offered via a bottle with latex nipples of varying hole sizes (original, intermediate, and 1-mm) depending on the infant’s needs. Despite only one study meeting the inclusion criteria by specifying thickener type and/or feeding modality, 11 tuto-rial and seminar articles that discussed milk thickening as an intervention strat-egy in this population were identified. However, these articles lacked any infor-mation on the type of thickener and feeding modality, and none implemented the intervention with infants. Conclusion: Although milk thickening is described as a strategy in several tuto-rial and seminar articles, there is a paucity of empirical evidence to support milk thickening as a feeding intervention strategy for infants using cleft-adapted feeding methods.