Children with clefts at higher risk of malnutrition, death - report

Every three minutes, a baby is born with a cleft around the world, or about 195,000 babies each year.

A cleft occurs when certain body parts and structures do not fuse together during fetal development and can involve the lip and/or the palate (the roof of the mouth).

A new report is now warning that children with clefts are almost twice as likely to be malnourished as their peers without clefts, unless aggressive interventions are taken.

The ‘State of the World’s Cleft Care Report a Generation Lost: The Devastating Effect of Malnutrition on Children with Clefts’ was released by the Institute of Health Metrics at the University of Washington’s School of Medicine, and Evaluation and Smile Train.

According to the report, clefts make eating and feeding, and especially breastfeeding, difficult.

The presence of a cleft reduces an infant’s ability to create suction, making it difficult or impossible for them to get milk, and even swallow, leading to excessive air intake, choking, and gagging, as well as an increased risk of infection from the presence of milk in their lungs and airways.

Exhausted by their struggle to feed, or feeling deceptively full due to the large amount of air in their stomachs, babies with clefts often stop nursing before they have adequate calories and nutrients.

The report warns that without adequate nutrition in these critical months and years of development, babies and children with clefts often become underweight and at risk of growth failure and death.

"Malnourished babies and children are also at increased risk of complications from anesthesia and surgery and are known to heal less quickly,” the report warns.

“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, leads to delayed speech development, and permanently impacts a baby’s overall health and development”.

The report further notes that when malnutrition persists for a long time, or is not reversed, health problems may continue into adulthood.

As a result, survivors of childhood malnutrition have been found to have shorter adult stature and earlier onset of health issues like obesity, diabetes, kidney disease, and obstructed labour, as well as cognitive problems that lead to poor performance in school and lower lifetime earnings.

Experts warn that the malnutrition crisis has been exacerbated by global calamities such as the Covid-19 pandemic, climate change, conflict and over-dependence on rain-fed agriculture.

According to Nkeiruka Obi, without the right nutrition, children with clefts are not optimized for surgery thus risk death before their first birthday and growing up with untreated cleft creates an obstacle to their social and economic wellbeing.

“It is our hope that this valuable data will help inform government policy and prioritize interventions through a more strategic and multi-disciplinary approach towards maternal and child health,” Obi said.

Obi is the Smile Train vice president and regional director for Africa.

It is estimated that one in every 1,200 Kenyan babies is born with a cleft lip or cleft palate.

Most children with untreated clefts live in isolation, making it hard for them to find friends or go to school.

Data shows that as of 2020, nearly 200,000 children with clefts were malnourished globally, and most of them live in LMICs while since 2000, 46,000 children under 5 with clefts have died from malnutrition-related causes.