Monday, May 10, 2010

When It's More Than Just A Cleft Lip and Palate

One of my childhood friends had a baby a few years ago that was born with a complete cleft lip and palate (unilateral). Luckily, after several surgeries and speech therapy, the young boy caught up with his development. But some families are not as lucky. Sometimes there are more things going on with the child. Often, these things are obvious such as heart or kidney defects, genetic syndromes, or neurological impairments. Other times, the problems are mild so it takes longer to get noticed; even the ones that are genetically linked. I'm not sure if the pediatrician doesn't refer the children for genetic testing or if the family doesn't find it necessary to meet with a geneticist.

Since cleft lips and palates may occur due to a neural tube defect that takes place during the first trimester of pregnancy, other parts of the body- especially in the mid-line may have not been formed properly either. Somethings I often see in children with cleft lips and palates include dysgenesis of the corpus callosum, global hypotonia, poor crossing of midline, swallowing problems (esophageal), and strabismus (eyes turning in). These children luckily get referred for occupational therapy (OT) and/or physical therapy (PT) in addition to speech therapy. The ones who do not get referred right away are often the ones with mild hypotonia and incoordination on both sides of their body; maybe they are just a little behind with their fine-motor and gross-motor skills as a toddler or preschooler. If this is not addressed, these children approach school with a disadvantage and all of the sudden a mild delay that is not addressed becomes a significant delay. This is when it is helpful to have a speech therapist (SLP) who knows alot about motor skills so that they can properly refer to PT and OT. If you are a parent or SLP who is wondering when it is appropriate to refer to PT/OT, then consider the following:

- Can your child keep up with his/her peers at birthday parties, playgrounds, or other group situations? Does the child fatigue easily?

- Can he/she jump by age 2 1/2? Ride a tricycle by 3 y/o? Do jumping jacks by kindergarten?

-Can the child play in a variety of postures: on the belly in the floor, in side-sit, ring-sit or criss-cross, long-sit, or kneeling?

- Does the child have a hand dominance by preschool age? even when there is a dominance the child should be able to use both arms and legs as well as cross the middle of the body. Does the child ignore one of his hands or efficiently use 2 hands such as to throw a ball and manipulate interlocking blocks? Does the child rotate his body in the chair to avoid crossing the midline of the body?

-Can the child feed himself with utensils age-appropriately? hold a cup?

-Is the child's pre-writing or handwriting skills delayed or sloppy?

If the answers warrant concern, then it is suggested that your child receive a PT and/or OT evaluation. After the evaluations, the therapists can discuss if therapy intervention or home exercise program are needed.

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