As soon as possible. Particularly if the team has an Orthodontist, they can start work on the cleft immediately. especially if nasoalveolar moulding is involved
These patients should be referred as soon as the diagnosis is made. In many cases, this is now at the 20 week ultrasound scan. An early referral to the cleft team at this stage allows appropriate counselling of the parent(s) regarding teh management protocol for their child. At birth, early intervention by the speech pathologist can help optimise the feeding of the baby prior to the lip repair.
These patients should be referred as soon as the diagnosis is made, but the surgery of cleft lip after 10 weeks of age, bod weight more than 10 pound , Hb% more than 10 and WBC less than 10,000. Cleft palate surgery after one year of age and less than 18 months .At birth, we give a spacial cleft Palate breast product of Chicog for feeding and after repair of clef palate we transfer babe to speech pathologist can help optimize of the speech .
Immediately upon diagnosis for the following reasons - Access to reliable information and support. Feeding advice. In the case of Pierre Robin sequence - the detection and management of neonatal airway obstruction is critical. The airway obstruction is intermittent and may be missed if the neonate is not assessed by a specialist team, including respiratory paediatrics. In the UK we advise maternity units to phone their local cleft team who visit the baby in the neonatal ward.
In the case of an antenatal diagnosis (often at a 20 week scan in the UK), foetal medicine specialists are advised to make a referral by phone to the cleft team before the parents leave the sonography department. This allows the expectant family to meet the team and receive reliable information about future care for their baby, rather than being left worried with only the internet as a source of information.
@ Dr. Walter J Flapper
How speech pathologist can help optimise the feeding of the baby prior to the lip repair??
Infants born with a cleft of the palate (with or without cleft lip) are unable to breastfeed effectively and require special feeding equipment (such as squeezable bottles and teats) and many mothers need specialist feeding advice and support. While some maternity service providers and Maternal Child Health Nurses are able to provide general feeding support to new mothers, there remains significant confusion amongst both the lay and professional community about the effective feeding interventions for infants born with CL/P. As a result many families receive conflicting advice and experience significant and unnecessary emotional distress and fatigue during the first year of life if they are not able to access specialist cleft feeding support services. From the RCH cleft unit website
http://www.aph.gov.au/DocumentStore.ashx?id=0a94b815-0b26-459a-908c-7c9b1f0ae7b0&subId=32893
I would agree with Walter' s comments that there is a great deal of confusion concerning the feeding in the early weeks. The sooner information can be provided to the family, the better, to ensure that a child has the best opportunity to gain the weight required to prepare for upcoming surgery. . It is also a way to identify if the family has other needs that are not being met. A good team should have a pediatrician, social worker or psychologist, audiologist, and speech pathologists, in addition to the surgical and dental providers. Clefts can also be an indicator of other potential anomalies that may prompt genetic testing. Identification in utero is also helpful when possible for this reason. This allows parents an opportunity to prepare themselves for what may be to come. There is a small percentage of false positives in the ultrasound readings, however and we must be careful how we approach these concerns.
Immediately after the birth of a child with CLAP, A Consult should be sent to the cleft team, at with time a paedodontist or an orthodontist will come and see while the baby is in the ward. Referral to the cleft team should be immediately after discharge from the ward.
the answer to your Q may vary depending facilities you have at your disposal.In a third world country where medical facilities are not optimal visiting baby immediately may not be feasible.
The baby should be screened as soon as possible by Pediatrician who has special training in cleft lip and palate for 1. screen for other congenital abnormality,2. feeding/ instruction to mother general need including psychology
Next patient should be seen in the cleft team where cleft surgeon and other specialist will be examine to plan the treatment.
In our center where we handle 1/3 of country cleft population, all Rx given free of charge and information book giving the total care is given to the parent. ( In their own language)
You can real by book through fallowing link.
https://www.researchgate.net/profile/Parakrama_Wijekoon
Book CHILDREN BORN WITH CLEFT LIP & PALATE
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