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Wisdom Wednesday: There’s a Pea In Your Nose!

There it was.  A little green pea was making its way out of Ellen’s nose.  I knew it was possible. I had heard the stories of raisins, kernels of corn, chocolate and even noodles sneaking their way into a toddler’s nose.  It’s all part of having a cleft palate.

Even after having a cleft palate repaired, often little holes or fistulas still remain.  Some are very obvious in the palate near where the two front teeth would be.  Some are a little more hidden and can be found in the gum.  Either of these locations lends itself to lunch or dinner remnants showing up in the nose.  The mere act of swallowing literally pushes food between the tongue and the palate thus pushing it through any little hole.  And unfortunately, food sometimes shows up in peculiar places.  Some children figure out how to keep food out of their nose while others are cheered on at the lunch table as they pull a noodle out of their nose.

Unfortunately, until the hole is closed surgically or with an obturator/retainer, food may continue to be found creeping into the nose.  Most physicians recommend a drink to try and wash food particles out or a good nose blow to try and clear any food out of the nose.

Surgery to close a hole or fistula is another part of having a cleft palate.  But how many surgeries do most children with cleft palates endure?  Well, there are the ones most people think of:  cleft lip and cleft palate repairs.  But some children will go on to have surgery to reshape the nose or to have ear tubes inserted.  Some children will have surgery to reshape the lip or for another set of ear tubes.  And then at about eight years of age, most children with cleft palates will have a bone graft surgery to fix the missing bone in the upper gum line.  Multiple surgeries are part of having a cleft palate.

Almost every child with a cleft lip and palate will have ear issues.  Having a cleft palate means that muscles of the palate did not develop appropriately, leaving a hole in the roof of the mouth.  Those same muscles are necessary to effectively work the eustachian tubes of the ears.  These are the tubes that drain fluid out of the ears, ultimately preventing a hearing loss or ear infection.   Many children with cleft palate will end up with ear tubes. Tiny little pieces of plastic can be inserted in the ear drum to allow the ear to drain any fluid or infection.  If left alone, the fluid backs up in the middle ear, causing a child to have limited hearing or hearing that sounds muffled and can lead to further damage of the middle ear.  Not being able to hear clearly can affect that child’s abilities to learn a new language, and to pronounce sounds correctly.  Ultimately, without good hearing the development of good speech can suffer.  Ear tubes, hearing tests, and ear issues are part of having a cleft palate.

And what about speech?  Speech production is an intricate orchestra of muscles, movements and air pressure.  Children with cleft lip and palate often require speech therapy to refine these movements.  Many children who are internationally adopted require speech therapy not only for speech production but also for the development and understanding of language.  Speech therapy often occurs weekly ranging in time from 30 to 60 minutes every week.  But those 30 to 60 minutes of speech therapy is just the tip of the iceberg.  There are worksheets and word lists to be completed and practiced daily.  Speech therapy can last a short period of time, such as a few months, but sometimes the needs are so great that speech therapy is required for several years.   Each child’s needs are individual, requiring a speech therapist to carefully craft goals and the process of meeting those goals.  Speech therapy is part of having a cleft palate.

Extra surgery, ear issues, ongoing speech issues and food in the nose are just a few of the often forgotten topics when adopting a child with a cleft lip and palate.  All are manageable and usually not permanent. However, it is very rare that a child who has a cleft lip and palate needs minimal intervention such as a couple of surgeries and they are just fine.  Cleft lip and palate are not considered life threatening, but having a cleft lip and palate is life-altering for both the child and the family.

~Christina Doelling is a mother of a four-year-old daughter who was adopted from China.  She is also a pediatric speech therapist with over 22 years of experience specializing in the needs of children who are internationally adopted and those that have a cleft lip/palate.

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  • Morgana armstrong says:

    Ellen’s pea up the nose gives a new twist to the story about the princess and the pea. Someone should write it. Meanwhile, how has Ellen fared? Adopted? Had surgery? On a list to receive it? Please let me know. Recently my daughter and I were studying cleft palate and discovered the smile train which probably doesn’t go to china. This year we celebrate her 10th anniversary of adoption from jinjiang orphanage.

  • Christina says:

    Julie
    Thanks for your question. Usually children with a cleft lip only do not have as many issues as those children with a cleft palate. Usually the only surgery is to repair the cleft lip and then maybe a touch surgery to lip later on. However if the cleft extends from the lip into the gum then a fistula may be present and bone graft surgery may be necessary. Usually children with a cleft lip only do not need speech therapy or have ear issues. However, each child and each cleft is different. Hope you find this helpful. If you have any more questions feel free to ask.
    Christina

  • Julie says:

    I was wondering if there are the same types of problems when there is just a clef lip? Ear problems, speech…

  • Amy Williams says:

    The very first meal we shared with our newly adopted cleft lip/palate child we ate noodles together. When one noodle emerged out of her nose I was stunned! However our son, then aged 11, exclaimed loudly in the restaurant, “Cool!” We all had a great laugh, and it is now a wonderful memory. Olivia is now 5 and has had her palate and lip repaired, and has speech therapy 3 times a week. She still needs the bone graft surgery coming up in a few years.
    I hope others will consider adopting a precious child with cleft lip and or cleft palate because of your article. Thank you!

  • Sidney says:

    Thank you Christina. This article was very helpful and informative!

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