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Cleft Lip and Palate: Supporting Oral Feeding from Birth through Palatoplasty, presented in partnership with Cincinnati Children's

Cleft Lip and Palate: Supporting Oral Feeding from Birth through Palatoplasty, presented in partnership with Cincinnati Children's
Ann Clonan, M.Ed, CCC-SLP, Brenda Thompson, MA, CCC-SLP, BCS-S
February 21, 2017
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This text-based course is a transcript of the webinar, “Cleft Lip and Palate: Supporting Oral Feeding from Birth through Palatoplasty,” presented by Brenda Thompson, MA, CCC-SLP, BCS-S; Ann Clonan, M.Ed, CCC-SLPThis course is presented in partnership with Cincinnati Children's.

Editor's Note: This transcript contains several videos.  You will need to view the course from a computer in order to access them (Note: the videos do not have audio).    

Brenda and I have worked in both the inpatient and outpatient arenas of our hospital and specialized with this population in both of those settings for many years. That experience has led us to the development of both our expertise for this population as well as our approach to providing the services considering the individual feeding challenges. It is based on the beliefs that many of these infants can be very successful oral feeders and that expertise is critical to these patients and their families. It assures that appropriate interventions are implemented promptly to maximize that infant's oral feeding function resulting in the best outcomes for growth, general health and development. It also contributes significantly to that family's feeling of success.

Learning Objectives

After this course readers will be able to:

  • Explain the oral structures and their responsibility to support oral feeding
  • Describe how commercial cleft bottles support more efficient oral intake with patients with cleft lip and or palate
  • List other interventions to support best outcomes for feeding

We will specifically focus on the anatomical consideration for oral feeding and clefting's impact on feeding and swallowing, the assessment and intervention for infants with cleft lip and or palate including materials and goals. We will address this at the following stages: newborn, transitional stage of puree and cup drinking, and palatoplasty.

Embryology

What is a cleft and how does it occur? A cleft is a result of failure of fusion during embryonic development of the face. It can be caused by both genetic interactions as well as exogenous factors which may include therapeutic agents, alcohol consumption, cigarette smoking, the nutritional status of the mother, folic acid deficiency or pre-gestational diabetes. In the last 10 years in utero diagnosis via ultrasound at the cleft as well as possible related syndromes has increased and allows families to be better prepared for and educated regarding the infant's medical and developmental strengths and challenges.

Development of this area occurs early on, specifically at the fourth week. Specifics by week are noted below:

  • 4th Week
    • Develop median frontonasal prominence and paired maxillary prominences and mandibular prominences
  • End of 4th week
    • Inferior frontonasal prominence divides into medial and lateral nasal prominences
    • Nasal alae are formed by elevation of the lateral nasal prominences
  • End of 6th week
    • Upper lip and primary palate complete formation by fusion of bilateral maxillary prominences with 2 medial nasal prominences.
  • 6th to 7th week (Secondary palate)
    • Bilateral palatal shelves of maxillary processes begin vertical growth phase and transition to horizontal growth
    • Palatal shelves fuse in midline and fuse to primary palate anteriorly as well as with nasal septum
  • 8th week
    • Ossification occurs of anterior aspect of secondary palate (differentiates hard from soft palate)
  • 10th week
    • Palatal development is complete

(Hartzell et al, 2014; Development of The Palate, Review of MEDICAL EMBRYOLOGY, BEN PANSKY, PhD, MD, 1982)


ann clonan

Ann Clonan, M.Ed, CCC-SLP

Ann Clonan, M.Ed, CCC-SLP, is the Inpatient Clinical Manager in the Division of Speech-Language Pathology at Cincinnati Children's Hospital and Medical Center with 25 years experience. She specializes in providing service for communication/development, feeding and swallowing (clinical and instrumental) to infants (and their caregivers) throughout the inpatient environment with a primary focus in the level IV medical-surgical Neonatal Intensive Care Unit (NICU). She also provides services to those infants/families with their transition to Neonatal Follow up Clinic and the Craniofacial Center. She has completed training for NDT and NICAP.


brenda thompson

Brenda Thompson, MA, CCC-SLP, BCS-S

Brenda Thompson, MA, CCC-SLP, BCS-S, is a full-time Speech-Language Pathologist at Cincinnati Children's Hospital and Medical Center with 20 years experience.  She is on the inpatient team of Speech Pathologists and is dedicated to the level IV medical-surgical Neonatal Intensive Care Unit (NICU) and provides additional follow-up care for infants in the craniofacial center. In her role, she provides clinical feeding and swallowing and instrumental swallowing evaluations using videofluoroscopy (VFSS) and Fiberoptic Endoscopy (FEES) to identify swallow function and assist with determining interventions to support safe feeding.  In addition, she provides ongoing care to support feeding, swallowing and global infant development and provides caregiver education to support parent-infant interaction during feeding and play. She is a board certified specialist in swallowing and swallowing disorders from the American Speech-Language Hearing Association.  In addition, she is a certified/reliable examiner in the Neonatal Oral Motor Assessment Scale (NOMAS) and the Nursing Child Assessment Satellite Training (NCAST). Ms. Thompson does many lectures and seminars on a state and national level in the areas of swallowing and swallowing disorders, neonatal feeding, feeding and swallowing in medically-fragile infants and toddlers, and cleft palate and craniofacial anomalies and their impact on feeding and swallowing.  



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