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Format(s):
SIG Perspectives
Feeding infants with orofacial clefting presents a unique and complex clinical challenge
requiring individualized care strategies and collaborative practice with providers from a
variety of disciplines. The three articles in this SIG 5 activity collectively emphasize the
importance of clinical expertise, evidence-based, and patient- and family-centered
approaches to feeding interventions for this population.
The first article is a qualitative study which explores the current feeding practices
and training experiences of expert healthcare providers (one registered nurse, one nurse
practitioner, and two speech-language pathologists [SLPs]) who work with infants with
cleft lip and/or palate. Through interviews with the four experienced professionals, the
study reveals significant variation in practice approaches, education pathways, and
challenges in interdisciplinary collaboration. Analysis of their qualitative interviews
reveals four sequential themes, (1) Informal Education and Training, (2) Multidisciplinary
Practice Issues, (3) Clinical Decision Making, and (4) Recommendations. The discussion
highlights that all providers relied most heavily on their clinical experience and had a
desire for more formalized training mechanisms in this specialized area of care.
The second article is a clinical focus piece which highlights the value of
collaborative assessments between Registered Dietitian Nutritionists (RDNs) and SLPs
when working with children with cleft lip and/or palate experiencing feeding and growth
challenges. The authors outline recommended materials, intervention timelines, and
assessment tools to guide joint evaluations. Using frequently asked questions,
resources, and case studies, the article demonstrates how combined evaluations
enhanced patient care by addressing both nutritional needs and feeding skill
development. The authors propose that dyadic visits between RDNs and SLPs support a
more holistic, family-centered approach to feeding intervention for patients with clefts.
The third article is a tutorial to help clinicians determine appropriate feeding
methods and interventions for infants with orofacial clefts. It builds upon the oral
peripheral exam as the critical first step to identifying signs of feeding difficulty in this
population. Authors then review cleft-adapted bottle options, flow rates, and strategies to
ensure sufficient nutritional intake, including nipple and infant positioning, milk
fortification, and others. The article emphasizes individualized intervention, thorough
documentation, and the need for ongoing monitoring. This framework is intended as a
starting point for conducting detailed oral exams, customized feeding plans, and to
effectively communicate feeding techniques and rationales to caregivers.
Feeding infants with orofacial clefting involves more than just managing anatomic
challenges—it demands a coordinated, knowledgeable, and compassionate team effort.
The articles in this activity offer valuable insights into current practices, persistent gaps,
and promising strategies that can guide clinicians toward more consistent, effective, and
family-centered care.
Format(s):
SIG Perspectives
This SIG 5 Perspectives course contains articles that discuss the psychosocial impacts of craniofacial care on patients and their caregivers. The articles include a literature review highlighting pediatric medical traumatic stress (PMTS) and findings of a survey examining how psychosocial barriers impact patient and family compliance with home exercise programs (HEPs).
Format(s):
SIG Perspectives
This SIG 5 activity includes three articles from a forum aimed at sharing research
conducted in clinical settings around the world. Two research articles analyzed surgical
and parent-led therapy approaches for improved speech and resonance outcomes. A
third tutorial described characteristics needed in an evaluation to analyze clinically
obtained data for research purposes.
The first research article is based in Brazil. It demonstrates positive long-term
outcomes in children with hypernasality/velopharyngeal dysfunction using the
Sommerlad procedure of palatal re-repair to treat residual velopharyngeal insufficiency.
The reported scores were in the categories of: “hypernasality, global impression of
velopharyngeal function, and/or active speech symptoms.” Overall, this study shows
significant improvement in a large percentage of children, with less effect on older
individuals ages 17–22 years.
The second research article includes parents from a previously published twocenter
study in Ireland and the United Kingdom. The aim was to analyze parents’
experiences with parent-led articulation therapy (PLAT) following in-depth training. After
a detailed outline is provided regarding inclusion and teaching of the participants, four
main themes are identified. These include growth of parents, undertaking PLAT,
changes in children, and the future. Ultimately, the majority of parents are in favor of a
parent-led therapy approach with the caveat that in-depth training and direct supervision
from a speech-language pathologist is needed.
The third article, a tutorial, addresses the research–clinical practice gap. A
description is provided of a perceptual speech assessment protocol for cleft palate
speech, to enable clinical data to be used for research purposes. The article provides
detail related to determining the most appropriate standardized assessment tools as well
as the best ways to collect and analyze this data. Further details related to
implementation within the clinical setting are outlined. The data is easily accessible
through networking between cleft teams and Sweden’s national cleft lip and palate
registry, making retrospective research attainable in a clinical setting.
Format(s):
SIG Perspectives
This SIG 5 activity analyzes the relationship between the opioid crisis and cleft lip and palate care across the life span. Two main themes of prevention and treatment after exposure are explained. The articles outline alternatives to opioid use after cleft-related surgeries, impacts on infants and children who were exposed in utero, and velopharyngeal insufficiency treatment after substance abuse.
Format(s):
SIG Perspectives
This Perspectives activity highlights two articles with objective measures for both evaluation and treatment of velopharyngeal dysfunction. The first article discusses the palatal closure efficiency (PaCE) index. This is an aerodynamic tool used to estimate the velopharyngeal opening during certain speech contexts. This is done by measuring a percentage of change between nasal and oral cognates of an individual. The second article describes the nasometer in depth, highlighting its use as an evaluation and treatment tool for decreasing hypernasality. It goes into further detail on the differences between hypernasality and measured nasalance, highlighting both strengths and limitations of the nasalance score.
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