title: Nutritional standard for children with orofacial clefts.
abstract: BACKGROUND
  Treatment of children with orofacial clefts is a multi-stage process, usually extending over many years and requiring intervention of numerous specialists. Most of the problems in such children before the tissue reconstruction surgery are related to feeding and airway protection during swallowing. Feeding of children with orofacial clefts is the more difficult the more severe the defect is. Such children are at an increased risk of body weight deficit and malnutrition.
  
  
  OBJECTIVE
  The aim of the study is to present the nutritional standard for children with orofacial clefts. Feeding principles for children with orofacial clefts: If the clinical state of the child and the emotional state of the mother allow, children with orofacial clefts should be breastfed or bottle-fed with breast milk. If feeding with breast milk is not possible, children should receive appropriate formulas for infants. Their diet can usually be expanded at the same time as in healthy infants and should comply with the nutritional model or standard for children aged 6-12 months. Various feeding techniques are used in children with orofacial clefts, depending not only on the type of the defect, but also the experience of the institution taking care of the child. Such children may require a diet with higher calories due to their increased energy expenditure related to eating. In the case of body weight deficit and/or malnutrition resulting from inadequate diet, a change of the feeding technique should be considered, and, subsequently, a diet modification. The modification may mean an extra formula feeding (in children fed with breast milk) or earlier introduction of supplementary foods. Sometimes a different feeding method than oral feeding must be used, e.g. through a naso-gastric tube or, in extreme cases, a feeding stoma. It is of utmost importance that infants with the said defects gain the optimal body weight before the planned operation, since malnutrition may be a significant reason for delaying the planned operation; it may also have an adverse impact on the healing of wounds and increase the risk of postoperative complications.
  
  
  CONCLUSIONS
  Infants with birth defects in the form of orofacial clefts are at risk of developmental disorders and, in particular, body weight deficit. Systematic assessment of their nutritional status aims at identifying potential irregularities, defining their underlying reasons and implementing an appropriate treatment. In the therapy of children with orofacial clefts, an individualised, comprehensive approach to nutrition, in line with recommendations of the team taking care of the child, is of utmost importance.
authors.affiliation: Zakład Żywienia, Instytut Matki i Dziecka, Kasprzaka 17a, 01-211 Warszawa, Poland, growicka@gmail.com.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Rowicka
authors.forename: Halina
authors.initials: H
authors.lastname: Weker