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We acknowledge that this paper is not intended to focus on specific medical or surgical problems that cause faltering growth but rather on a general approach of assessment and management in these children.
Several online resources have been recognised by the guideline committee and we believe one further guideline may be beneficial to your audience. Ineffective suckling, clicking sounds or nasal regurgitation whilst feeding may indicate a cleft palate or submucous cleft palate undetected at newborn assessment. This recent best practice guide produced by the RCPCH promotes the following six recommendations to ensure early detection of a cleft palate:
1. Healthcare professionals should examine a baby’s hard and soft palate as part of the full newborn physical examination and record this in the child health record.
2. Examination of the baby’s palate should be carried out by visual inspection.
3. A torch and method of depressing the tongue should be used to visualise the whole palate.
4. Parents should be informed if the whole palate (including the full length of the soft palate) has not been visualised during the newborn examination.
5. If the whole palate is not able to be visually inspected at first attempt then a further attempt at visual examination should be made within 24 hours.
6. Trusts should provide training on the correct method of visual inspection of the palate to all healthcare professionals required to carry out the newborn examination. 1
According to the CRANE annual report, in 2015, 28.3% of children born with a cleft palate had a late diagnosis (more than 24 hrs after birth). 4.3% were diagnosed after one month of age and some patients may not yet have had their cleft identified.2 Analysis performed by CRANE over the last five years has shown that diagnosis times for detection of cleft palate have not improved in recent years. This delays referral to specialist cleft centres and more importantly delays valuable input from specialist cleft nurses. We hope that you find this resource as useful as we have.