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

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.38106.559120.7C (Published 10 June 2004) Cite this as: BMJ 2004;328:1405

Cleft palate, premature death and learning disabilities

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: No competing interests

11 June 2004
Woody Caan
professor of public health
Department of public and family health, APU, Chelmsford, Essex CM1 1SQ, UK
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