Babies from 0 to 6 months with fissure have an anatomical disadvantage which makes nursing difficult. This goes together with the lack of information by the family and the lack of economic resources which prevents access to substitute or complementary products.
When the child grows up and can eat other food apart from maternal milk, malnutrition continues to be a big problem which we need to face due to the children’s dental problems.
The nutritionist carries out work in orienting the family by recommending a balanced diet according to age which will allow adequate physical and psychological development in the child.
Dental prevention treatment is of great importance for children of all ages, especially if the child has cleft palate and lip.
Periodic exams are important in order to detect signs of cavities or infections, together with the attention that should be paid to invaluable advice of the dentist about good mouth hygiene, which is difficult since , very often, fissured children have their teeth placed too close together or out of their normal place.
The use of fluoride and sealers helps to strengthen and prevent cavities. A balanced diet according to their age which should include soft as well as solid food will help strengthen the children’s teeth.
In every orthodoncic treatment we seek to improve three aspects:
Function: a bite that works well.
Esthetics: a bite that looks good.
Orthodoncic treatment, in most cases, starts with permanent teething, although some treatments, such as palatal expansion, can start at an earlier age. Orthodoncic treatment also helps improve the functions of mastication (chewing) and speech. Fissured children can have any of the typical problems of children without fissure. Among the most common we have:
Teeth that are too close or tight together.
When the fissure is present, additional problems can occur such as:
Total lack of teeth.
Teeth defective in shape or varnish.
Teeth that grow out of their normal position.
The upper jaw does not grow in coordination with the lower jaw.
Prostodoncy Some fissured children will not have all their teeth or will have some out of place. The prostodoncist replaces the missing teeth.
A very high percentage of fissured children suffer from ear infection due to the incomplete development of the palate and the palatal muscles which are needed to open the Eustaquian tube, which fulfills an important function in the ear. It is necessary for children born with fissure to be under the supervision of an ear, mouth and throat specialist in order to avoid future damage. Among the most common problems we have:
Middle otitis (middle ear infection).
Rinitis (nose infections).
Ear problems affect sound production (speech) since the child cannot hear or has impaired hearing. Thus, the child will not produce the correct pronunciation of words. This will affect personal relationships in their environment since the child will not be able to discriminate sounds adequately. Pediatrics
The pediatrician has an important role in the interdisciplinarian treatment, since she/he coordinates the diffrent specialists. Integral evaluation of the fissured child must be carried out periodically from the time of birth by a pediatrician, who should:
Discard other birth anomalies, for which she/he will work with a neurologist and a geneticist.
Initiate a management plan in order to achive adequate growth and development in the child.
Achieve adequate nutrition which is indispensible for the surgeries needed by the child. This will be done in coordination with the nutritionist and the surgeon.
The birth of achild brings about changes in the family dynamics, the attitude of parents, siblings and grandparents. In turn, this has an important role in the psychological developemnt of the child. That is why it is imporatnt for the parents of a fissured child to receive orientation and support in order to know what to do and what treatments are becessary. In the psychilogical evaluation it is important to carry out a diagnosis of:
Family dynamics and its impact on the fissured child.
Determine the intelligence quotient of the fissured child and if there is an organic realtion.
Determine the emotional stability of the child, their skills or abilities and their limitations.
This evaluatuion is very important in order to determine the treatment in physical therapy, speech, voice and language therapy as well astreatment in other specialties such as odontology. In order to deal with the problems of fissured children, ARMONIZAR, has created the following services within the area of psychology: Family Counselling This a space where professionals guide and support the parents in order to motivate them and orientate them throughout the child’s treatment. The information received by parents and the guidance given for the treatment and upbringing of the children helps diminish the physical and emotional wear of the families. Social Skills Workshops These constitute a good alternative to facilitate personal relationships, since fissured children can be marginalized or overprotected. In the workshops we use painting, dance and sculpture as means of development for the children. Learning and readiness / preparation workshops The majority of children born with cleft palate and lip perform normally at school. However, some fissured children have learning difficulties. Among the factors related to fissure which cause problems we have:
Loss of hearing.
Language problems (spontaneous speech, reading and writing).
The most common learning problems in fissured children are:
Short term memory.
In the learning and readiness workshops, we carry out activities to reinforce or motivate the psychological processes related to learning, such as:
Auditory and visual memory.
Fine and gross motor coordination.
Associative reasoning of ideas, logical-mathematical.
Children born with cleft palate and lip must be evaluated in their neuromuscular development, in their motor area and their psoture. Early detection of pathologies is very important for adequate treatment. Neuroevolutive evaluation assesses if there is harmony in the developement of children from 0 to 2 years of age, preventing delays in their development. After the evaluation, if necessary, the baby together with the mother partcipates in therapies which foster normal growth and development. In the motor area, children over 2 are evaluated in their fine and gross motor ability, by observing the child’s performance in their environment. According to their needs, children take part in therapies which are complemented with guidance given to parents for more work in their daily life. With posture evaluation, problems in the locomotor system are diagnosed such as syphosis, escoliosis and flat foot. Early disgnosis allows early treatment and the prevention of future problems both esthetic as well as functional, for example in breathing and speech. Early Intervention Program
Early intervention in fissured babies is not well known in PERU. A baby born with cleft palate and lip presents a variety of problems which require the attention of several professionals. Apart form the necessary surgeries, there may be other problems: in speech, teeth or the emotional area. Besides it is important to give the family information so they can help towards an effective rehabilitation of the affected children. Early treatment of these babies is of the utmost importance so as to prevent or minimize the sequels inherent to those born with this malformation. Early intervention in fissured babies can start before birth. At present it is possible to find out through tests during pregnancy whether the child will be born with fissure. The program carried out before birth is called PRE NATAL EARLY INTERVENTION, where the orientation to parents is one of the most important activities. The POST NATAL INTERVENTION PROGRAM is carried out from the birth of the child to the age of 3. In this program the child will be attented to together with the parents in th following areas:
Intellectual or cognitive.
Within the program there are periodic controls of:
Habits (food , hygiene, sleep).
Speech, Voice and Language Therapy
Children with cleft palate and lip suffer alterations in speech, language and voice. The presence of these problems will depend on:
Degree of anatomical affection of the patient.
Personality and intelligence quotient of the child.
Family dynamics and environment.
Among the problems faced by therapists we have:
Speech omission problems- that is when the child communicates through signs.
Speech difficulties due to bad articulation where some phonemes may substitute others (glottal stop, faringeal fricative).
Presence of nasalized speech.
For the effective design of a treatment plan, it is important to have the child examined by the specialists:
Otorrinolaringologist (Ear,mouth, throat).
It is important to start treatment at an early age in order to prevent or minimize the sequels that are common in this malformation..