Occupational Therapy/Feeding Therapy
Like all babies, most infants with clefts are born ready to eat, either from the bottle of breast. But they may need special care during feedings. Due to the size and type of your baby's cleft, he/she may not be able to create enough suction and strength to draw milk from the breast or bottle. Babies with cleft tend to get tired quickly because they use more energy trying to suck the milk from the bottle or the breast. For that reason, there are special nipples that can be used along with feeding appliance to help with your baby's feeding. Our occupational Therapist will assist you in choosing an appropriate feeding bottle for your baby. Our occupational therapist also sees patients in the NICU, PICU and the general pediatric units. In addition to diagnostic services (feeding and swallowing evaluation), they provide early stimulation, sensory integration therapy, feeding therapy and a complete range of activities to help children develop the self-help and daily living skills they will need as they grow-up and mature. Balance and head/trunk control issues are also addressed by occupational therapist.

Physical Therapist
Our physical therapists see in patients and out patients for developmental evaluation and assess your child's balance, pre-gait or mobility training, and to help improve gross motor skills, muscle strength and tone. They provide therapy to help children become functional and independent.

Speech and Language Therapy
A speech and language pathologist is a specialist who is trained to evaluate speech and language development and advise you of any treatment that might be helpful.

There are two main types of speech problems caused by cleft palate:

  1. Articulation: This refers to being able to produce sounds correctly. Children who cannot correctly pronounce certain words have articulation errors. Articulation problems may be caused by oral structures that are incorrectly developed, or by a child substituting a different sound because she is unable to produce the correct one. For example, instead of saying the sound /t/ the child may substitute the sound /k/. The word "two" may be pronounced as "koo." There are many variations of these disorders and poor speech habits often result when a child tries to find other ways to make difficult sounds.

    Hearing loss is one of the possible reasons for speech and language problems of children born with cleft palate. When children do not hear sounds well, they may repeat them as they hear them. For example, if the child is having difficulty hearing high frequency sounds, such as /s/ and /f/ (which is common in children with fluid in their ears, and high pressure build-up), the child may hear the word "son" as "fun"; this problem can affect the child's articulation, as well as her ability to learn language.

  2. Nasality: During speech, the soft palate (a structure attached behind the hard palate in the roof of the mouth) opens and closes a "doorway," the nasopharynx. This doorway is hidden and cannot be seen by looking in the mouth. It directs air from the throat to the mouth (most sounds) or the nose (/m/, /n/, /ng/) in order to make speech sounds. If the soft palate doesn't close the doorway when it should, a number of speech problems can result.
    1. Hypernasality occurs when the soft palate allows air to pass through the nose during words that should not be nasal; as a result, speech sounds too nasally.
    2. Hyponasality: When the opening is too small, speech may be hyponasal, because the air cannot pass into the nose when it should. As a result, it may be hard to make nasal speech sounds like /m/ /n/, and /ng/. A small opening can also cause breathing problems and snoring as in the case of large tonsils.

The Speech/Language Pathologists with the cleft team at White Memorial Medical Center will do everything they can to make sure the child has the tools to build normal speech and language skills.

Nutritional Therapy
Our team of registered dietitians at White Memorial Medical Center sees cleft palate patients in the inpatient areas (pre- and post-surgery) and the outpatient area (cleft clinic). The dietitians provide instructions, recommendations to parents and staff and medical personnel on how to achieve an appropriate caloric intake in order to reach a desired weight gain for the child. They calculate caloric intake and give dietary suggestions, healthy food choices and education to parents on how to achieve their nutritional goals for their child.

Comprehensive Pediatric Rehabilitation Services <link to Pediatric Rehabilitation Services: Speech Therapy, Occupational Therapy, Physical Therapy>