June 20 Post Two

When Thomas was born, besides the cleft palate, he seemed to be a healthy baby. He had all of the necessary reflexes. Thomas had the sucking reflex yet it wasn’t as strong as other infants his age. Because his cleft involves the hard palate, Thomas was not able to suck efficiently. The doctor informed Taylor that when she feeds Thomas, he should be held in a nearly sitting position during feeding to prevent the breast or formula milk from flowing back into his nose. In addition, Thomas should be burped frequently, approximately every three or four minutes (Children’s Health, 2014).

Around 5 weeks after birth Thomas was crying more than usual. This started to concern Taylor so she consulted Thomas’s doctor who told her that crying reaches its peak around five weeks after birth and it is the vital way Thomas communicates his feelings. Taylor is sleeping less and wants to know when Thomas will grow out of this stage of crying insistently. The doctor informs her that this crying rate will decline around four months because as the cortex blossoms, crying rates decline, and babies will only use this mode of communication selectively. The doctor also encourages Taylor to take advantage of when the baby cries to pick him up, and rock him to enhance the parent-child bond (Belsky, 2013).

Around 9 months Thomas started to show a delay of speech and speech sound development compared to typical children his age. He especially made grunt and growl noises which concerned Taylor. The doctor notified Taylor that these sounds represent a behavior that some children learn in attempt to compensate for velopharyngeal inadequacy which is the inability to close off the nasal cavity from the mouth. Thomas also started to have ear infections often due to a dysfunction of the tube that connects his middle ear and his throat. Since, recurrent infections can then lead to hearing loss. To eliminate any confusion, Thomas is taught English in the home so that he can properly learn the native language before he is taught Spanish. Being able to be

bilingual can be very beneficial for a child, but since Thomas already has a speech delay, Taylor thinks that it is more importantly to focus on learning one language correctly (Speech Development, 2012).

Because cleft palate causes many disadvantages within the child, Thomas’s parents decide to have cleft palate surgery at 12 months. Since there were no facilities nearby, Taylor had to take off work to travel to the Craniofacial center in Morris Town, NJ. The first surgery repaired the palate and involved palatal lengthening and drawing tissue from the left side of the mouth to rebuild the palate. Because of the procedure, Thomas had to stay three nights in the hospital, the first night in the intensive care unit. Taylor and Marcus decided to have the surgery done because of the benefits. This surgery created a functional palate and reduced the chances that fluid will develop in the middle ears, and helped the proper development of the Thomas’s facial bones. In addition, the functional palate helped Thomas’s speech development and feeding abilities. Because of the dysfunction in his oral cavity, Thomas’s teeth development was irregular. As a result of the abnormalities present, his teeth would eventually require orthodontic treatment.  Since Thomas has a cleft palate, he is more prone to a larger than average number of cavities than typical children and he has displaced teeth requiring dental and orthodontic treatments. The first dentist visit is usually at three years of age but because of the specific dental problems that cleft palate causes, Thomas was recommended to see a doctor at 12 months (MUSC, 2014).

Taylor and Marcus have similar religious views and are very involved in their church. This was a very supportive system present especially when Thomas was having his surgery. Since Taylor couldn’t take off much work, church members went and stayed with Thomas in the hospital after his surgery. Other church members made meals and dropped them by the house so that Marcus and Taylor didn’t have to worry about cooking. It is not easy putting your own child through surgery but this church family was a huge blessing and support for Taylor and Marcus during this difficult time. The church family also assist in transporting Thomas to and from speech therapy sessions because of the restricted schedules of Thomas’s parents. Although surgery helped with Thomas’s speech production, he also began speech therapy at one year and a half and has been making significant progress with his articulation and with his “s” sounds. Since Thomas is a part of the Children’s Health Insurance Program, his parents didn’t have to worry about covering the cleft palate surgery or speech therapy costs because they were covered under New Jersey’s CHIP program. Under the Benchmark-Equivalent coverage, the surgical and medical services, inpatient and outpatient were covered for Thomas. 

Around 2 years Thomas began to be squirmier, less able to cuddle, and required more attention. After researching, Taylor found that there are some signs in babies that tend to have a positive correlation with ADHD later on. ADHD doesn’t suddenly develop when a child reaches school age, but instead, most research shows a high correlation between genetics and ADHD. Most children, however, are not diagnosed with ADHD until past the age of 6 (ADHD 2014).

1)    What other coverage does New Jersey’s CHIP (Children’s Health Insurance Program) have that may be beneficial for Thomas?

2)    Thomas will develop a musical prodigy, at what age should the first signs of a prodigy appear?

3)    If Taylor and Marcus have another child, what is the likely hood of the child having a cleft palate?

4)    How long is the typical cleft palate surgery? And what is survival rate of this surgery?

5)    What is the relationship between parent/child attachment and later diagnosis of ADHD? Consult the literature.

Decision Point:

Does the family consult a pediatrician regarding Thomas becoming “squirmier, less able to cuddle, and requir[ing] more attention?” Why or why not?

References

ADHD in Children: Birth Through 12 Months. (2014). Remedy Health Media, LLC. Retrieved from http://www.healthcentral.com/adhd/raising-child-with-adhd-278672-5.html

Belsky, J. (2013). Infancy. Experiencing the Lifespan. New York: Worth Publishers .

Children's Health- Encyclopedia of Children's Health . (2014). Advameg, Inc.  Retrieved from http://www.healthofchildren.com/C/Cleft-Lip-and-Palate.html

Cleft Palate. (2014). Medical University of South Carolina. Retrieved from https://www.muschealth.com/gs/healthtopic.aspx?action=showpage&pageid=P01847

Speech Development . (2012). Cleft Palate Foundation. Retrieved from http://www.cleftline.org/parents-individuals/publications/speech-development/