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.