The Cleft Lip and Palate Program at Arkansas Children's Hospital uses a comprehensive multidisciplinary team to provide your child's care. Each team member specializes in pediatric health. The team's goal is to ensure that care is provided in a coordinated, consistent manner. We schedule testing, appointments and treatments with your child's overall developmental, medical and psychological needs in mind.

The Cleft Lip and Palate Team at ACH is fully accredited by the American Cleft Palate Association (ACPA) and is one of many programs at ACH which provide high quality, individual service to children with special health care needs.

ENT surgeons, Dr. Larry Hartzell and Dr. Adam Johnson not only perform the primary cleft repair and bone grafting but provide comprehensive expertise in otologic and airway issues that may arise.  Dr. Johnson also directs the Velopharyngeal Insufficiency Clinic (VPI) dedicated to both cleft and non-cleft patients experiencing speech disorders. 

Plastic Surgeon, Dr. Sagar Mehta, chief of plastic and reconstructive surgery and craniofacial team director, specializes in primary cleft lip and palate surgery, alveolar bone grafting, orthognathic (jaw) surgeries, and cleft rhinoplasty.

Possible Conditions

Possible Treatments

Our Cleft Lip & Palate team has extensive experience treating all types of clefts and related disorders.

Nasoalveolar Molding (NAM)

NAM was originally developed by an ENT & Plastic Surgeon, Dr. Court Cutting, and craniofacial orthodontist, Dr. Barry Grayson at New York University (NYU) and is now available with all surgeons at Arkansas Children's. Not all babies with clefts are candidates for NAM, but for those that are, the retainer-like device can greatly help to narrow the width of the cleft, the gums and improve nasal shape.

Health at Home

Web Resources

We know the concern families must experience when a newborn is born with a cleft lip and palate condition. However, learning all you can about these conditions can help you understand your child’s situation and enable you to ask your doctor about any new developments in treatment. The following links provide the latest information on these important topics:

Camp Laughter Supports Patients

The cleft and craniofacial teams at Arkansas Children’s Hospital collaborate with Camp Aldersgate to provide a one-day camp for children living with cleft and craniofacial differences and their family members. Camp Laughter is a free annual event that occurs the first Saturday in August. This all-day event is for kids ages 5-18, who are in school and have a cleft or craniofacial difference. They can participate in various outdoor activities while connecting with other children just like them.

Arkansas Children’s Cleft Team Provides Humanitarian Work in Ecuador

Adam Johnson, M.D., Ph.D., otolaryngologist, cleft surgeon and velopharyngeal insufficiency (VPI) clinic director, and Larry Hartzell, M.D., FAAP., director of cleft lip and palate program, have participated in several medical mission trips over the years and have made ongoing commitments to the organization. Read more about their missions. >

Important Facts

  • Weight should be taken and recorded at least once every week
  • Keep a feeding log with date, time, amount taken and length of feeding
  • Feeding should last less than 25 minutes
  • Most newborns during the first few weeks will feed 8-12 times per 24 hours
  • Pumped breast milk and infant formula mixed with water should be the only liquids fed through bottles

Goals for your Baby

  • Feeding for optimal, adequate growth and development
  • Feeding should be less than 25 minutes
  • Meet growth and weight goals for corrective surgery (8 pounds or more for lip repair and 18-20 pounds for palate repair)
  • Limited pacifier use
  • Baby foods fed by spoon starting at 4-6 months based on the feeding progression chart discussed with you by our clinic dietician
  • At 6 months, or when there is good lip closure for spoon feeding, offer formula or breast milk from a cup
  • Babies needing palate repair should be skilled at drinking from a cup before palate surgery

Types of Special Bottles

Pigeon Bottle –Y-cut nipple with one-way valve; contains an air valve to prevent collapsing while sucking. Large or small nipple options are available and assistive squeezing is possible.

Dr. Brown’s specialty bottle with one-way valve and air vent system to reduce gas.

Haberman bottle with one-way valve and variable flow rates; assistive squeezing is possible.

Tips for using specialty bottles

  • Consult with Speech Pathology for bottle selection
  • Do not screw the collar of bottle on too tight
  • Hand clean bottle and nipples with warm soapy water and rinse well (do not boil or use in dishwasher)
  • Replace nipples every 1-2 months
  • Check with your surgeon’s clinic for a new supply

Feeding Your Baby

  • Follow exact mixing and feeding instructions provided on discharge or in clinic
  • Baby should be in a slightly reclined position during and after feeding
  • Increase feeds weekly by 5 ml each feed. If you feed 60 ml feeds on discharge, then the next week feeds should be at 65 ml each and 70 ml the following week.
  • Burp baby after every few ounces
  • Clinic dietician will review infant feeding progression before introducing solid foods
  • When child has progressed to table foods, avoid gummy or sticky foods or foods with sharp edges

Weight Gain Goals

Email or call your baby’s weight to the nutritionist weekly.

Goals for Weekly Weight Gain

Age  Weight Goals
 1-3 months  6-8 ounces
 4-6 months  4-5 ounces
 7-12 months  2-3 ounces

Contact Info

For questions related to feeding your infant contact:
Karen Bright, MS, CLL-SLP
brightkl@archildrens.org

For questions related to your infant’s nutrition contact:
Joanna Daughety, RD, LD
Clinical Nutritionist, ENT Clinic
501-364-7541
daughetyj@archildrens.org

Helpful Websites:

Meet the Team

Pediatric Otolaryngologist/Plastic Surgeon - These specialists are responsible for the surgical closure of the cleft and related operations which your child may require. Any ear disease, speech disorder or hearing loss, will also be closely monitored and treated by these physicians. 

Audiologist - Since children with cleft palate have an increased risk of ear problems, ongoing audiological surveillance is necessary. The audiologist provides appropriate assessments for monitoring hearing status so that diagnosis and treatment can be made for any cleft-related hearing problems. 

Dental Specialist - The dental specialists include the pediatric dentist, orthodontist, oral surgeon, periodontist, and prosthodontist. These specialists keep track of your child's dental growth and development and provide information on oral hygiene and dental treatment that may be necessary due to the cleft. 

Geneticist - The geneticist alongside his genetic counselor, is available to discuss how clefts of the lip and palate occur and to answer questions about the risk of recurrence with future pregnancies. Later, this specialist can help your teenager understand the cause of a cleft and advise him or her about individual circumstances.

Neuropsychologist - The neuropsychologist is available to discuss you or your child's concerns.
 
Speech Pathologist - The speech pathologist will provide you with information about typical speech development along with suggestions for stimulation speech when your child is very young. Speech and swallowing dysfunction will be closely monitored and appropriate treatments or therapies will be prescribed at Arkansas Children's or if appropriate, closer to home. 

Social Worker - The clinical social worker is available to meet with the family to assist in the psychosocial and emotional aspects of cleft lip/palate. This specialist is aware of services available in the community to which the family can be referred for information on medical coverage, financial assistance, and support groups/services. 

Clinical Nutritionist - The nutritionist assists with any early feeding difficulties and monitors the child¹s nutritional intake. This specialist also provides follow-up of weight gain and height/weight parameters and provides information and support with specific diets related to some of the surgeries. 

Registered Nurse
- The nurse is available as a contact person to provide information and ensure that parents understand their child's health needs, treatment plan and follow-up. This specialist assists with the child's presurgical readiness and post-surgical recovery and provides instructions for home care.

Related Content

Locations

Make an Appointment

Children may be referred for evaluation and treatment at the cleft clinic by physicians, speech therapists, teachers, families, guardians or others concerned with their general growth and development. 

To make an appointment at the cleft clinic, please contact Jo McCallie, cleft team administrative assistant, at 501-364-7546, or Jordan Davis, cleft team coordinator, at 501-364-1658Dr. Larry D. Hartzell, director of the cleft lip and palate program, can be reached via e-mail at cleftteam@archildrens.org.

  • The Cleft Multidisciplinary Team Clinic meets the first Wednesday of each month.
  • Regular, New and Follow-Up Cleft Clinics meet weekly and vary per surgeon.

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