Tagged "cleft"

Ask a Therapist: Cleft Palate and Feeding Therapy

Posted by Deborah Grauzam on


I've taken your courses for Down's syndrome and Assessment and Planning. I'm fairly new to feeding, but am having some success with Down's clients (thank you and they thank you :).

I just got a 15 month old with cleft on my caseload.  He's had lip repair and his palate only has a small hole after surgery (will be fixed at 3).  His mother said she used a squirt bottle because he couldn't suck (and still uses it before he goes to bed).  He can drink from a cup without spilling if it only has a tiny amount in it.  Is there any reason this child could not start using a straw or have more control with a cup with intervention?  His upper lip has no movement for retraction or protrusion, but he does get closure for the /m/ sound.



Thanks for your email. I am so glad you have been using what you learned in the Down syndrome class with success! You should absolutely start working on upper lip mobility and lip rounding with this child!  You may have to work through the scar tissue, and I have found that a vibrating upper lip stretch (one gloved finger under the scar, one outside the lip on top, use a vibrating movement with your fingers through the scar tissue) or a myofascial release.  Then do your upper lip stretch, and mickey mouse /m/. Once you get mobility, start doing single sip cup drinking.

Best of luck and let me know how your client progresses!

Lori Overland

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Ask a Therapist: SMILE protocol for Severe Diagnosis

Posted by Deborah Grauzam on


I would like to know if your SMILE program would help someone who is not a tongue thruster but has other abnormalities like a restricted tongue movement because of extra frenulum material, a malformed tongue, and a cleft (somewhat repaired). In other words I already know that programs can reach a variety of patients. Mine is an adult with not only all of the above problems but has just had teeth implants top and bottom. Her tongue and its relation to the teeth, and cleft (nasality) are her problems. I listened to a recording of her voice before implants and it sounded somewhat more clear but not substantially.

Thank You,

Thank you for your question. If this client does NOT have VPI and the nasality is the result of the tongue tip being poorly elevated then YES. I have treated multiple clients with nasality issues because the tongue was low or the tip was anchored due to restricted frenum. What is very important is that the client has the mobility to execute the program. If there is a severe tongue tie surgery may be needed prior to implementation.

Thanks for your interest,

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