Sample Care Team Timeline
The timeline indicates the intervention of care in the growing period of a child with a cleft. Note that team care (i.e. at least yearly evaluations by the whole cleft palate team) extends throughout the years to adulthood.
- Routine care by the family pediatrician and dentist also covers this period.
- Surgical intervention is intermittent, depending on growth.
- Audiologic/Otologic care is particularly important during the first three to four years. Speech and language development depend on the child’s ability to hear the world. Speech and language are monitored for the development of proper use of the musculature of the mouth. Any problems noted during speech acquisition, or created by the growth of structures, or caused by surgical procedures can be addressed in a timely manner and corrected before they become permanent.
- Pediatric dental consultants evaluate and inform patients and their families of the importance oral hygiene.
- Orthodontic intervention may be necessary to assist with alignment of structures to facilitate surgical correction. This may be needed just after birth, during the “mixed dentition” phase to align the dental arch, and even in the teen years due to jaw growth. Prosthodontics may be necessary to facilitate speech, fill in missing teeth due to the cleft, or supplement inadequate structures that are present.
- Genetic consultations are recommended to determine a more accurate diagnosis for the plan of care, to clarify the risk of future children having a cleft, and the patient’s risk of having a child with a cleft.
- Social service is provided for support of the individual as well as the family, and act as a resource for available services. This is an integral part of team care.
- Evaluations by a team pediatrician and nurse also keep the general health and welfare of the child in perspective at each critical stage.
Any deviation from the optimum path noted along the child’s progression toward adulthood can be adjusted to minimize its impact on the team goal: an adult that can compete favorably with his or her peers. Today a repaired cleft should not interfere with obtaining a good job, having a satisfying social life, and being successful as an individual.
Comprehensive longitudinal craniofacial team care minimizes the number of surgeries by timely communication and coordination of the various surgical needs and other needed interventions. Overall, the cost is lower and the results are better for the child and family.