CLEFT LIP AND PALATE - THE ROLE OF SPEECH AND LANGUAGE THERAPY
CLEFT LIP AND PALATE - THE ROLE OF SPEECH AND LANGUAGE THERAPY Speech and Language Therapists (SLTs) have either an undergraduate or postgraduate de...
CLEFT LIP AND PALATE - THE ROLE OF SPEECH AND LANGUAGE THERAPY Speech and Language Therapists (SLTs) have either an undergraduate or postgraduate degree. Most courses are four years in duration. SLTs work in health centres, hospitals and voluntary bodies. SLTs work with children and adults with developmental and/or acquired speech, language, feeding and swallowing, voice and general communication difficulties Julie Young The Children's Hospital 24th September 2002
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FROM BIRTH TO 12 MONTHS FROM 12 MONTHS TO 3 YEARS FROM 3 YEARS ONWARDS
Julie Young The Children's Hospital 24th September 2002
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FROM BIRTH TO 12 MONTHS Feeding Multidisciplinary team involvement Communication Assessment and Guidelines
Julie Young The Children's Hospital 24th September 2002
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FEEDING There are squeezable bottles available such as the Mead Johnson and the Haberman. These will help your baby if he/she has a weak suck. The Mead Johnson is cheaper and available from the Cleft Lip and Palate Association. It is suitable for babies who have some difficulty with sucking. However, it is a soft bottle and does not last as long as other bottles. It is generally easier to use than the Haberman. Julie Young The Children's Hospital 24th September 2002
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The Haberman bottle is more expensive and available from Medicare. It is also suitable for babies with difficulty sucking. The teat, rather than the bottle is squeezable so you don’t have any difficulty sterilising the bottle. It is a bit more awkward to use. The Haberman is more suitable for babies who have more significant feeding difficulties and particularly for children who have Pierre-Robin Sequence (cleft palate and a small chin). Julie Young The Children's Hospital 24th September 2002
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Ask your Speech and Language Therapist about what bottle they think is most suitable for your child.
Julie Young The Children's Hospital 24th September 2002
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Not all babies need a squeezable bottle. Some will do fine with an ordinary bottle with an enlarged teat. Some do not have any difficulty at all with feeding. It does not always depend on the type of cleft.
Julie Young The Children's Hospital 24th September 2002
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FEEDING - GENERAL GUIDELINES Feeds should take no longer than 30-45mins Your child should be fed in a semi-upright position. Your baby may need to be winded more often due to extra air being sucked in while feeding. Don’t worry if some formula/milk comes down your babies nose he/she should learn to control this in time. Julie Young The Children's Hospital 24th September 2002
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FEEDING - CONT. Your baby should move onto semi-solids and solids the same way as a child without a cleft. This will often be easier than bottle feeding.
Julie Young The Children's Hospital 24th September 2002
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MULTIDISCIPLINARY TEAM The Speech and Language Therapist (SLT) works as part of a Multidisciplinary team. The SLT will attend your regular appointments at combined clinics. The SLT at the combined clinic will arrange referral to the SLT in your local area. Julie Young The Children's Hospital 24th September 2002
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SLT has a role in developing and maintaining communication between parents and the multidisciplinary team.
Julie Young The Children's Hospital 24th September 2002
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COMMUNICATION ASSESSMENT
Your child should have a Communication assessment between 6 and 12 months. This should be an individual consultation with your SLT. It should involve discussion with parents and completion of checklists rather than direct work with your child. The focus of assessment is on general communication skills. Julie Young The Children's Hospital 24th September 2002
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GUIDELINES The guidelines the SLT gives you should include information on: Encouraging your babies general communication development. z z
Receptive language Expressive language
Encouraging your babies speech sound production. z
Lip, tongue and palatal movement Julie Young The Children's Hospital 24th September 2002
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GUIDELINES - CONT. The Child with Cleft Lip Only - if speech difficulties are evident they are not usually associated with the cleft lip. 40-50% of children born with a cleft lip and/or palate will have speech difficulties. This means that 50-60% will not have speech difficulties and therefore: IT IS IMPORTANT TO TREAT YOUR BABY AS NORMALLY DEVELOPING. Julie Young The Children's Hospital 24th September 2002
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GUIDELINES - CONT. It is important to recognise the difference between: a) Language comprehension - the words that your child understands e.g. ‘put the blue brick in the red box’ b) Language expression - the words that your child uses e.g. ‘brick box’ c) Speech - the sounds that your child uses to say these words e.g. brick -> ‘bik’ box -> ‘bok’ Julie Young The Children's Hospital 24th September 2002
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GUIDELINES - CONT. Be aware that your child may be using more words than you think. At this age the SLT does not work directly with your child. Parents are the most important facilitators at this stage.
Julie Young The Children's Hospital 24th September 2002
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FROM 12MONTHS TO 3 YEARS
REGULAR MULTIDISCIPLINARY TEAM REVIEWS. MONITORING SPEECH AND LANGUAGE DEVELOPMENT.
Julie Young The Children's Hospital 24th September 2002
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MULTIDISCIPLINARY TEAM REVIEWS Your child will usually attend for annual reviews - unless otherwise agreed. The SLT who attends the Combined Clinics will monitor your child’s progress and be available to answer any questions.
Julie Young The Children's Hospital 24th September 2002
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MONITORING SPEECH AND LANGUAGE DEVELOPMENT Monitor hearing. Your child should have a hearing assessment at approximately 12 months. Referral to an ENT -Ear, Nose and Throat Consultant can be arranged if necessary. If your child has fluctuating hearing difficulties it is important to be aware that this can affect language development. Julie Young The Children's Hospital 24th September 2002
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SLT at combined clinic will liase with your local Speech and Language Therapist. Children are referred to your local Speech and Language Therapist from the time of first contact due to long waiting lists. This is just to make sure your child is in the system if he/she requires Speech and Language Therapy at a later stage. Julie Young The Children's Hospital 24th September 2002
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Your child is still not ready for direct Speech and Language therapy input.
Julie Young The Children's Hospital 24th September 2002
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FROM 3 YEARS ONWARDS
SPEECH ASSESSMENT THERAPY
Julie Young The Children's Hospital 24th September 2002
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SPEECH ASSESSMENT Your child should have his/her first full speech assessment at approximately 3 years of age. Children are generally unable to co-operate before 3 years as they need some pre-school skills such as: z z z z
sitting at a table listening to and following directions allowing someone else to direct activity adequate language development in order to obtain an adequate speech sample. Julie Young The Children's Hospital 24th September 2002
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SPEECH ASSESSMENT - CONT. An adequate speech sample is necessary in order to be able to make recommendations regarding therapy. The recommendations may be that your child’s language, rather than speech, development should be a priority. Your child may present with developmental speech errors not associated with the cleft palate. Julie Young The Children's Hospital 24th September 2002
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Your child may present with cleft type speech errors which are associated with his/her cleft palate. The SLT may identify speech difficulties related to problems with palatal function. This is known as‘velopharyngeal dysfunction’ or nasal speech.
Julie Young The Children's Hospital 24th September 2002
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The SLT may recommend further investigation of palatal function if age appropriate. Your child should have regular speech assessments at each multidisciplinary clinic. REMEMBER!! 50-60% of children born with a cleft lip and/or palate will not have speech difficulties. Julie Young The Children's Hospital 24th September 2002
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THERAPY Your local Speech and Language Therapist decides when therapy is required. Therapy may not always be the answer. SLT’s work on a block basis with breaks from therapy.
Julie Young The Children's Hospital 24th September 2002
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Breaks from therapy are essential to allow generalisation of the work covered. Your SLT may decide just to see your child on a review basis. Therapy might be direct work with your child. It could be direct work with the parents.
Julie Young The Children's Hospital 24th September 2002
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PARENTS AND NOT SLTS PLAY THE MOST IMPORTANT ROLE IN YOUR CHILD’S SPEECH AND LANGUAGE DEVELOPMENT SLTs are the assessors and planners Parents are the THERAPISTS.
Julie Young The Children's Hospital 24th September 2002
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RECOMMENDED READING A Parent / Child Cleft Palate Curriculum, Developing Speech and Language. Brookshire, Lynch & Fox 1980.
Julie Young The Children's Hospital 24th September 2002
