The following is an excerpt from a lecture given by Dr. Gyikua Plange-Rhule, MB ChB, MWACP, FGCP LLB of Smile Train’s partner Komfo Ankoye Teaching Hospital in Kumasi, Ghana. It was delivered as part of Smile Train’s Telecleft Online Lecture Series featuring talks from cleft experts across Africa.
Children born with a cleft will often present with other birth differences as well. They also have a higher risk of illnesses like severe acute malnutrition and respiratory illnesses, among others. Nearly 30–40% of children who have a cleft will have another associated birth difference or syndrome. Every child with a cleft needs to be carefully examined by a pediatrician prior to surgery to confirm that they do not have other issues that may affect their recovery and overall growth.
Pediatricians play a critical role as both nutritionists and lactation consultants, encouraging and counseling mothers on effective methods of feeding their babies. Since they are often the first point of contact with the family, pediatricians will also play the role of family doctor, offering the best possible guidance on care for the baby.
During visits, pediatricians should give parents greater insight into what the child may be experiencing. Some conditions present as triggers to further conditions and hinder the possibility of cleft surgery. For instance, an umbilical hernia could be a sign of something like hypothyroidism. There have been cases of parents self-medicating this hernia, making things worse for their child.
When taking care of children, it is important to make the most accurate diagnosis possible because other problems (e.g. heart failure) will need to be identified and treated in good time. A child with multiple medical issues may need to see several specialists, and pediatricians are often best placed to coordinate this care. Pediatricians are also able to determine the prognosis of a child with a syndrome, which will help the team discuss the child’s realistic outcomes with their parents and avoid expensive imaging and labs in preparation for surgery. Pediatricians must also ensure that the child is brought to cleft surgery in the best possible state of health.
In conclusion, the exact role of the pediatrician in cleft care depends on what health personnel and resources are available both in the team and in the health system generally. This role is vital if we aim to achieve holistic care for our patients. First and foremost, we must see children as children and not “clefts”!
For this and more of the Telecleft Online Lectures visit our YouTube Page.
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