We understand that you might be worried about coronavirus – also known as COVID-19 – and the impact of a delay to your child’s planned cleft surgery. This information sheet from the Welsh centre for Cleft Lip and Palate team at Moriston Hospital is for children, young people and families who use our services.
Please read this together with national advice from CLAPA available here:
We recognise that any potential delay to the usual timeline for cleft surgery can be a potential cause for distress. Please rest assured that the South Wales Cleft Team are doing their very best to deliver surgical care for your baby as close to the original timeline as is feasibly possible in the setting of reduced surgical capacity across the health board. Your cleft nurse specialist will be in contact with you individually to keep you updated. Should you have any concerns, please do not hesitate to contact us.
Alveolar bone graft
For our older patents, alveolar bone grafting is usually carried out between the ages of seven and ten years of age. The precise timing depends on general dental development. This can vary a lot and delays for a few months in the surgery should not greatly impact on the development of your child’s teeth. Some patients will need preliminary work with orthodontic braces. If your child has braces, it is very important that good oral hygiene is maintained in the run up to surgery.
Dentists across the UK are only providing emergency dental care. This is for your protection as well as the safety of the dental team. If your child has toothache, you should manage this with over-the-counter pain relief such as paracetamol or ibuprofen, according to the instructions on the bottle or package. However, if your child is in extreme pain or they have a swelling, contact your local dental surgery to arrange a prescription or further treatment. You should also contact your dentist or GP if your child has trouble swallowing or noisy breathing.
You can also access NHS 111 at 111.nhs.uk. In an emergency, you should call 999 or take your child to your nearest A&E as usual. If your child chips or breaks a tooth, you should contact your local dentist to advise whether this can be addressed later or needs immediate care.
If your child knocks out a tooth, immediately put it back in the socket if you can, then ask your child to bite on a piece of clean cloth. You should then contact your local dentist. If you cannot put the tooth back, put it in milk, then contact your local dentist or go to A&E.
Your child should continue to look after their teeth and mouth as usual – brushing twice a day with fluoride toothpaste and avoiding sugary drinks and snacks. When restrictions are lifted and services return to normal, you should book an appointment with your local dentist in the normal way.
If your child has braces, they should carry on keeping their mouth and the brace clean by brushing twice a day with fluoride toothpaste, using interdental brushes and mouthwash. Avoiding sugary drinks and snacks too will help prevent damage and staining to the mouth and teeth. This is especially important if there is going to be a delay in getting an orthodontic appointment.
Those with a fixed brace should avoid hard, chewy, and sticky foods to reduce the risk of a breakage.
If your child has any problems with their teeth or the brace, please contact your clinical team at Morriston Hospital or your regular orthodontist. Further information, including videos, is available from the British Orthodontic Society at
Jaw, lip, and nose surgery for older patients
We usually carry out these operations when your child has finished growing, at the age of 17 years or older. We understand that you might prefer to arrange these procedures during the school holidays, but we cannot guarantee this. We will try to arrange the operation at a convenient time when restrictions are lifted, and services return to normal
Speech and Language Therapy
The Speech and Language Therapy team have put together an information sheet of activities (attached) and ideas for you to try out at home to encourage your child’s babble and speech development whilst waiting for surgery. This is available on our website at https://sbuhb.nhs.wales/hospitals/a-z-hospital-services/cleft-team/ and on our twitter feed @cleftteamwales.
The Speech and Language Therapy Team are continuing with some assessments and therapy sessions via virtual appointments. Please do not hesitate to contact the Speech and Language Therapy Team if you are concerned about your child’s speech.
Secondary speech surgery
During the coronavirus outbreak there may be a delay for those awaiting secondary surgeries and palatal investigations. The speech and language therapy team are able to offer virtual appointments and will continue to support your child’s speech development in the meantime.
ENT and Audiology
If you have concerns regarding your child’s hearing or if they are having ear infections, please contact your own GP, who can advise on appropriate management. Your GP can then contact the local ENT or Audiology service for advice or arrange a review, if necessary.
Some audiology services are offering video consultations, to help advise on hearing aids. If your child already has a hearing aid and you are having problems, please contact your local audiology service directly and they will advise you on what to do.
Routine clinic appointments
Clinicians are looking to remove the need for patients to attend face-to-face appointments wherever possible. This might involve telephone appointments or exploring video consultations. If your child has an upcoming clinic appointment, we will be in touch with you to discuss how we can best carry this out remotely.
We’re here to help
If you have any concerns relating to either your child’s cleft diagnosis or the impact that the changes to service delivery might have on your child, you might feel it helpful to discuss this further with our Cleft Team Psychologists. Similarly, if you have any concerns in relation to your child and any Covid related anxieties or distress, then it may be helpful to talk this through with one of the psychologists. If you would like to speak with a psychologist, then please telephone 01792 703810. We can arrange a time to talk over the telephone or through a video call.
You can also find some useful information regarding wellbeing during covid19 on the Children’s Commissioner for Wales website in the coronavirus information hub at https://www.childcomwales.org.uk/coronavirus/
Alternatively, the website https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing has some resources for parents/carers in relation to supporting children through this period, as well as advice for adults.
Further information and support Information from the NHS at www.nhs.uk/conditions/coronavirus-covid-19/
Information for children is available on the BBC Newsround website at www.bbc.co.uk/newsround
Ideas to Develop your Child’s Speech, Language and Communication Skills
There are many aspects of development that contribute to a child learning their first words and there are lots of activities that you can do with your child to encourage their speech and language development, before and after their palate repair.
When interacting with your child remember to keep distractions to a minimum and sit face to face, at the same level. Face to face contact is important so that the child can see all of your mouth movements when you talk, as well as your facial expressions.
Speech and language development can be encouraged during the daily routine by parents, siblings, grandparents and other carers and remember: the more fun that you are having, the more fun that your child will have!
Speech and Language Development Activities
Talk to your child: It sounds simple but remember to talk to your child throughout the daily routine. For example:
Remember to pause and listen to your child’s response, then praise and respond to any attempt at talking; no matter how coherent it may be.
Your child may try to communicate with you through physical actions; for example, by raising their arm to be picked up. Try to verbalise the action; for example, “up”
For further tips, visit:
Play with your child: Learning through play is the primary source of development for younger children. Play allows children to develop and practice new skills, including speech.
Engaging in pretend or symbolic play with your child is a great way of encouraging speech. This play involves imitating activities in your daily routine; however, remember to talk to your child whilst playing. For example, when making a cup of tea with the toy tea set say “pour my tea” or when putting teddy to bed, say “Goodnight ted”. Your child will love your involvement in their play and will develop and learn whilst you do.
For further ideas for children up to 5 years, visit:
Sing songs and rhymes with your child: Songs and rhymes, particularly those with actions, are a great source of motivation for your child and can teach not only words, but also pitch and volume. A great way to aid speech development!
For ideas of nursery rhymes and action songs to sing with your child, visit:
Read with your child: The importance of reading with your child cannot be overlooked. Not only will these help familiarise your child with the words it will come on to learn to read, but it will aid speech development and the development of good communication skills.
For advice regarding toddlers and technology, visit:
REMEMBER: You do not need to be an expert to aid the development of your child’s speech and communication skills.
Even the smallest things you do with them can make a big difference, so chat, play, read and sing at every opportunity and enjoy the time together!
Babble Therapy / Input Modelling
Babble therapy (or “input modelling”) is a technique used to reduce the risk of a child developing speech difficulties which are related to their cleft palate.
Before your child’s operation to repair their palate your child may find the sounds ‘m’ ‘n’ and vowel sounds such as ‘aa’, ‘oo’, ‘ee’ easier to produce. The reason for this is that these sounds can be made without the palate separating the mouth from the nose. Your child will find it easier to say words with these sounds for example; mum, nana, no, neigh, moo, mine, more, hiya.
It will be more difficult for your child to produce front mouth sounds such as /p/, /t/, /f/, /s/, ‘sh’, ‘th’. It is for this reason that children with cleft palate need to be given as many opportunities as possible to hear and see the front mouth sounds without any pressure to say the sounds. It is never too early to start showing your child these sounds.
You can help the development of these sounds by engaging your child in babble therapy at home.
This could be as simple as having your child watch you making the relevant sounds during play. You should not invite your child to repeat the sound, you should simply encourage your child to watch its production (though remember to praise your child if they do attempt to copy you).
You should ensure that each sound is modelled quietly and softly, to avoid the accidental encouragement of exaggerated or throaty sounds.
Top Tips for Babbling
For further babble therapy ideas, please see:
Your child will need to hear sounds and words hundreds of times before they produce them correctly.
REMEMBER: You do not need to be an expert to aid the development of your child’s speech and communication skills.
Go on, have a go and enjoy babbling with your child!