Care Children With A Cleft Lip Or Cleft Palate

Cleft lip (cheiloschisis) and cleft palate (palatoschisis), which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening—a gap. It is the non-fusion of the body's natural structures that form before birth. Approximately 1 in 700 children born have a cleft lip and/or a cleft palate. In decades past, the condition was sometimes referred to as harelip, based on the similarity to the cleft in the lip of a hare, but that term is now generally considered to be offensive.
 
Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. In 1976, Paul Tessier described fifteen lines of cleft. Most of these craniofacial clefts are even more rare and are frequently described as Tessier clefts using the numerical locator devised by Tessier.
 
A cleft lip or palate can be successfully treated with surgery, especially so if conducted soon after birth or in early childhood.
 
Children with a cleft lip or cleft palate are more likely to receive recommended age-appropriate health care when that care is provided by an interdisciplinary team rather than an individual provider. In a study encompassing three states, Arkansas, Iowa and New York, 24% of participants were not receiving team care.
 
The authors of the report, published in the January 2010 issue of the Cleft Palate Craniofacial Journal, found that mothers of children with orofacial cleft were twice as likely to give a lower rating of their child's cleft care when that care was provided by an individual rather than a team. Beyond surgical care, children with orofacial cleft may need dental care, hearing tests and speech therapy, emotional or behavioral care, help with learning difficulties, and genetic counseling about their condition.
 
A cleft care team consists of at least a surgeon, a dental professional, and a speech professional. This interdisciplinary team approach is recommended by the American Cleft Palate Craniofacial Association to ensure that these special-needs children are given appropriate care and referrals.
 
Study subjects were children born between 1998 and 2003 with a cleft lip, cleft palate, or both, and were identified through the National Birth Defects Prevention Study. Mothers of 253 of these children were interviewed for this study.
 
Children who do not have team care were less likely to have received noncleft-related medical care in the past 12 months. They were less likely to have had a hearing test in the past year and to ever have visited a dentist or received genetic counseling since the cleft was diagnosed. Those who did receive team care had more severe cleft conditions, however. Eighty-six percent of children with both cleft lip and cleft palate were receiving team care.
 
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