Long term follow up study of survival associated with cleft lip and palate at birth

Cleft palate, premature death and learning disabilities

11 June 2004

Christensen and colleagues (1) have produced a fine example of the long term health consequences of congenital anomolies, just at the time when the National Congenital Anomaly System in the UK 'is currently being reviewed' (2).

It is no surprise that risk of suicide is elevated, given that having a cleft in childhood can 'attract hostility and bullying' (3). A subtler point came up during our national study of speech therapy in relation to clefts (4): professionals were unanimous about the need for expertise 'across a range of presenting problems'. What Christensen et al (Online version) allude to as 'cognitive impairments' are quite common in the UK, i.e. cleft palate and co-morbid learning disabilities. Given that premature death is especially common in the population with learning disabilities (5), could this sub-group have accounted for most of the 143 excess deaths aged 0-55 in the Danish sample of 5331 births?

1 Christensen K, Juel K, Herskind AM, Murray JC. Long term follow up study of survival associated with cleft lip and palate at birth. BMJ 2004; 328: 1405-10.

2 National Statistics. The health of children and young people. London: ONS, 2004.

3 Caan W. Your shout. Department of Health: Mental Health Promotion Update 2002; 3: 16-17.

4 Caan W. Diploma Evaluation for CLeft Advanced Roles and Education (the DECLARE project). Report for the Royal College of Speech and Language Therapists (London), 1999.

5 Caan W. Epilepsy, early death and learning disabilities. http://bmj.bmjjournals.com/cgi/eletters/326/7385/349 19 February 2003.

Competing interests: None declared

Competing interests: None declared

Woody Caan, professor of public health

Department of public and family health, APU, Chelmsford, Essex CM1 1SQ, UK

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