Our clinics are held at Morriston Hospital or the University Hospital Wales, Cardiff. Please follow this link to our page - Find us: Our Wards and Departments for more information. Some appointments will be arranged locally, for example, a school visit by the Speech and Language Therapist or a home visit from the Clinical Nurse Specialist. You will be invited to some of these clinics during your journey with the cleft team – click on the subheadings to find out more. For more information on your cleft journey, please follow this link to our Patient Journey page.
Write down questions you want to ask. If you have letters or results from other departments or hospitals (for example, audiology), it is helpful if you can bring these along too. If you have forgotten to ask anything when you come, you can always contact us following the appointment to clarify anything. You can find out contact details by following this link to the Contact the Welsh Centre for Cleft Lip and Palate page.
We, at the Welsh Centre for Cleft Lip and Palate understand that attending clinic appointments can be difficult at times, so please contact us should you need support. Transport to health appointments can be arranged if we are told in advance.
It is your responsibility as a parent/carer to bring your child to their health appointment/s. This will ensure your child’s health needs are met, which in turn will give them the best possible outcomes in life.
Not all children are brought to clinics for treatment or to virtual sessions by their parents/carers and as a result, for no fault of their own, they miss out on scheduled care which puts them at considerable long-term disadvantage. We have a specific legal duty to ensure that all children born with a cleft receive the appropriate care due and needed, therefore we have implemented a Was Not Brought Pathway which is followed by all professionals within the cleft team.
“Every child has the right to health and healthcare” (UNCRC, 1989)
When your baby is between about 6 and 12 weeks, you will be given an appointment to come to the New Baby Clinic. This clinic is held once a month and it is a chance for you to come and meet the team. The team members you will meet at the clinic are as follows:
Specialist Cleft Nurses will welcome you to the clinic and make sure you have everything you need. They will check your baby’s weight and length and talk to you about how your baby is feeding.
The Consultant Cleft Surgeon will examine your baby’s cleft and will talk to you about the surgical treatment your baby will need. He will be happy to try to answer any questions you have.
The Psychologist/Assistant Psychologist will introduce themselves and the service (see Treatment and Support Page for more information about Psychological Support) and you will have the opportunity to discuss your child’s general mental wellbeing
You will meet the Consultant Paediatricians. They will ask some routine questions, examine your baby and carry out an echocardiogram (heart ultrasound scan) if this has not already been done.
You will meet the Consultant Paediatric Anaesthetist who will be able to answer any questions you have in relation to anaesthetic for surgery.
This is run by our Clinical Nurse Specialists and is usually held 6 weeks before your operation.
During this Clinic, we will give pre and post-operative advice, and will run through the pre-operative assessment. Any questions or concerns will be discussed.
At this appointment there will also be a member of the Clinical Psychology service. They will be available to answer any further questions within their area of expertise and will share information on the "my Hospital Adventure" booklet (previously known as the "Hospital Passport"). which will help explain what to expect when coming into hospital.
This is run by our Clinical Nurse Specialists and is usually held at 6-8 weeks following your child's operation.
The lip and/or palate will be examined and a plan for future follow up appointments explained. Any questions or concerns will be discussed.
At this appointment there will also be a Cleft Speech and Language Therapy Assistant and Clinical Psychologist/Assistant Psychologist. They will be available to answer any further questions in their areas of expertise.
When referred to the psychology service, you will be invited to attend our ‘Psychology First Appointment Clinic’. Here, you will meet with one of the teams Clinical Psychologists in order to discuss what concerns or questions you might have. An Assistant Psychologist may also be present at your appointment. Appointments are available for anyone born with a cleft lip and/or palate, as well as offering support to parents, siblings and other family members where necessary.
Within the clinic, we will first look to develop an understanding of the difficulty being experienced before looking to provide the necessary and appropriate psychological support. Appointments can last for up to an hour and can take place in person at Morriston Hospital or via a video call. We will work with you to understand how we can offer support and together agree the best way to proceed.
You will receive an appointment to attend a babble workshop when your child is aged between 6 – 12 months old. These appointments take place at Morriston Hospital and/or University Hospital of Wales, Cardiff. There are usually a small number of families at the session. You will be given some information about how the palate works and will receive advice about how to encourage your child’s speech development and how to discourage any cleft speech characteristics from developing.
A dental nurse also attends these clinics to give advice about dental hygiene and the best ways to look after your child’s teeth.
The Speech and Language Therapy team review children from age 18 months onwards. There are routine appointment check-ups as described in the patient journeys, depending on the type of cleft they were born with.
At age 18 months – 2 years the assessment is informal and your child will be observed playing while the SLT listens to the sounds and words that they are able to use. Parents will be asked some questions about their child’s overall development. It may be helpful to bring your red book to these appointments to remind you about some of their previous appointments and milestones. If you have any letters from other professionals, e.g. audiology or paediatrician, it can be helpful if you bring these along too. Your child can bring along a favourite toy or book.
These appointments are carried out at Morriston Hospital as we are able to use a 2-way mirror to observe your child playing if they are quiet around unfamiliar people. The room also has some soundproofing to help the SLT listen.
The SLT will listen to your child as they talk and will feedback to you at the session about how they think the palate is functioning and how their speech and language skills are developing.
From age 3, we aim to carry out a formal speech assessment. Your child will be asked to do some counting, recite a nursery rhyme (older children can recite the days of the week and months of the year) and copy some sounds and sentences. They will also be encouraged to use some conversational speech about anything that interests them. These assessments are likely to be audio or video recorded and we will ask for parental consent to complete this.
The SLT will listen to your child as they talk and will feedback to you at the session about how they think the palate is functioning and how their speech and language skills are developing.
Outpatient appointments are also arranged with SLT 6 months after any surgery which was carried out with the aim of improving speech. The SLT will carry out a formal assessment which they can compare to the assessment carried out before surgery to determine what level of improvement has been made and whether any further surgery might be beneficial. This will be discussed with you at the appointment and you are encouraged to ask any questions you may have.
All children will be seen at the age of 2 years old. Your child’s teeth will be checked by the Paediatric Dentist and you will have the opportunity to discuss any concerns with a member of the Psychology team.
Paediatric Dentist - The Paediatric Dentist will look in your child’s mouth and provide any dental advice.
Clinical Psychologist/Assistant Psychologist - This will be an opportunity to discuss your child’s overall wellbeing and explore any concerns that you may have.
Children born with a cleft will be invited to attend a clinic before their 6th Birthday. This is a multi-disciplinary clinic and on the day your child will see some or all of the following professionals:-
The Consultant Cleft Surgeon will discuss how your child is progressing and will discuss any possible future treatment. If needed, he will look in your child’s mouth and will be happy to answer any questions you have.
The Speech and Language Therapist will assess your child’s speech. We will ask parents/carers to give consent to audio and video record your child’s speech assessment. Our Speech and Language Therapists will prepare your child for what to expect and do our best to help your child feel at ease. During their speech assessment, your child will be asked to:
The Psychologist/Assistant Psychologist may see you on the day or speak to you prior to the appointment. This will be an opportunity to discuss your child’s overall wellbeing and explore any concerns that you may have. Follow this link for information about how to talk to your child about the cleft they were born with.
The Paediatric Dentist will look in your child’s mouth and provide any dental advice.
The Orthodontist will also look in your child’s mouth and provide any advice regarding possible future treatment.
Your child’s hearing will be tested by the Audiologist. The ENT Consultant will feedback the hearing results and discuss any possible hearing management plans with you and the team.
With your consent, photographs will be taken for the medical records.
Your child’s height and weight will also be taken at the clinic.
Following the clinic day, you will receive a letter summarising the outcome.
Some children born with a cleft lip have a gap in the gum. An Alveolar Bone Graft (ABG) helps to keep the teeth in the right place by taking some bone from your hip and putting it into the gap in your upper jaw inside your gum. You will be invited to attend a clinic at around 8 years old to decide if this will be needed. During this appointment, you will meet the Surgeon, Dental team, Orthodontist & Psychologist. Your child may have an x-ray and/or impressions of their teeth taken. Follow this link for more information about an Alveolar Bone Graft.
All children born with a cleft will be invited to attend a clinic before their 11th birthday and will be invited again before their 16th birthday. At these appointments you will have the opportunity to ask any questions that you or your child may have to the various relevant professionals. You will see all of the relevant team members on the day, some individually and some within the team consultation.
At these clinics your child will see some or all of the following professionals:
Consultant Cleft Surgeon - The Consultant Cleft Surgeon will discuss how your child is progressing and will discuss any possible future treatment. If needed, he will look in your child’s mouth and will be happy to answer any questions you have.
Speech and Language Therapist – The Speech and Language Therapist may assess your child’s speech. We will ask parents/carers to give consent to audio and video record your child’s speech assessment. Our Speech and Language Therapists will prepare your child for what to expect and do their best to help your child feel at ease. During their speech assessment, your child will be asked to:
If you have no further concerns regarding your child’s speech following the MDT clinic, that may be the last formal assessment that you will be called for. However, if you decide at any point in the future that you would like further advice or support, please get in touch.
Your child’s speech may not be routinely assessed at the 15-year clinic if there are no concerns prior to this, however, you can request an assessment. The Speech and Language Therapist will be present during the team consultation to answer any questions you may have.
Clinical Psychology Team - the Psychologist/Assistant Psychologist may see you on the day or speak to you prior to the appointment. This will be an opportunity to discuss your child’s wellbeing and explore any concerns that you may have.
During your appointment at the 10-year MDT clinic, you may wish to discuss transition to secondary school, changes in appearance or growing up. We will share our ‘My Story Resource’ book with you during this clinic, and you can also follow this link to access the ‘My Story booklet’.
At the 15-year clinic, you may wish to discuss transition to work or college, changes in appearance or growing up.
Paediatric Dentist - the Paediatric Dentist will look in your child’s mouth and provide any dental advice.
Orthodontist - the Orthodontist will also look in your child’s mouth and provide any advice regarding treatment. Impressions of your child’s teeth may be taken and where necessary, x-rays may be taken. The requirements for orthognathic surgery are discussed at the 15-year MDT appointment.
Audiologist and ENT Consultant - your child’s hearing will be tested by the Audiologist. The ENT Consultant will feedback the hearing results and discuss any possible hearing management plans with you and the team.
Medical Photographer - with your consent, photographs will be taken for the medical records.
Your child’s height and weight will also be taken at the clinic.
Following the clinic day, you will receive a letter summarising the outcome.
Patients are seen at 12 years of age on a joint clinic with the Paediatric Dentist and Orthodontist. They will check your child’s dental health, assess how the teeth are growing and check the bite of the teeth.
Paediatric Dentist - the Paediatric Dentist will look in your child’s mouth and provide any dental advice.
Orthodontist - the Orthodontist will also look in your child’s mouth and provide any advice regarding treatment. Impressions of your child’s teeth may be taken and where necessary, x-rays may be taken.
You will attend these clinics from the age of 18. At these appointments you will have the opportunity to ask any questions that you may have to the various relevant professionals. You will see all of the relevant team members on the day, some individually and some within a team consultation.
At these clinics you will see some or all of the following professionals:
Consultant Cleft Surgeon - The Consultant Cleft Surgeon will discuss any possible future treatment. If needed, he will look in your mouth and will be happy to answer any questions you have.
Speech & Language Therapist - The Speech & Language Therapist will be present during the team consultation to answer any questions you may have.
Clinical Psychology Team- the Psychologist/Assistant Psychologist may see you on the day or speak to you prior to the appointment. This will be an opportunity to discuss your overall wellbeing and explore any concerns that you may have.
Orthodontist - the Orthodontist will look in your mouth and provide any advice regarding treatment. Impressions of your teeth may be taken and where necessary, x-rays may be taken.
ENT Consultant - The ENT Consultant will be present and discuss any possible hearing management plans with you and the team.
Consultant Restorative Dentist - Restorative Dentists can advise and offer options with regards to how we fill any spaces in your smile and improve the function of your bite. They may also be able to help with some speech problems.
Medical Photographer - with your consent, photographs will be taken for the medical records.
Review clinics are held to discuss any problems your child may be having with any aspect of their cleft. At these appointments you will have the opportunity to ask any questions that you may have to the following professionals:
Consultant Cleft Surgeon - The Consultant Cleft Surgeon will discuss any possible future treatment. He will look in your child’s mouth and will be happy to answer any questions you have.
Speech & Language Therapist - The Speech & Language Therapist will be present during the team consultation to answer any questions you may have.
Clinical Psychology Team - The Psychologist/Assistant Psychologist will be present in clinic to give you an opportunity to discuss your child’s overall wellbeing and explore any concerns that you may have.
Cleft Dental Nurse - Our Cleft Dental Nurse will welcome you and your child to the clinic and discuss any concerns.
Review clinics are held to discuss any problems you may be having with any aspect of your cleft. At these appointments you will have the opportunity to ask any questions that you may have to the following professionals:
Consultant Cleft Surgeon - The Consultant Cleft Surgeon will discuss any possible future treatment. He will look in your mouth and will be happy to answer any questions you have.
Speech & Language Therapist - The Speech & Language Therapist will be present during the team consultation to answer any questions you may have.
Clinical Psychology Team- The Psychologist/Assistant Psychologist will be present in clinic to discuss your overall wellbeing and explore any concerns that you may have.
Cleft Dental Nurse - Our Cleft Dental Nurse will welcome you to the clinic and discuss any concerns.
If there is concern that you/ your child’s palate is not working as well as it should, you/ your child may be offered a ‘talking x-ray (Videofluoroscopy)’ or a ‘magic eye (Nasendoscopy)’. Follow this link for more information about the Videofluoroscopy and follow this link for more information about Nasendoscopy.
When you/ your child come for a palatal investigation clinic, the team will guide you through the stages described below.
The Videofluoroscopy clinic is held in Morriston Hospital. You/ your child will go into the x-ray room with the Speech and Language Therapist, Radiographer, Psychologist/Assistant Psychologist and Surgeon. A parent will be invited into this room to sit with the child. Everyone will put on a special apron. You/ your child will sit next to the x-ray machine and will be asked to say the sounds and sentences that they would have practiced in preparation. It will only take a few minutes and will allow us to see a side view of the palate during speech.
Some older children and/or adults may require an assessment using a ‘magic eye’ (Nasendoscope). A numbing spray will be placed in the nose and the magic eye will be placed into the nose. You/your child will be asked to say some sounds and sentences so the team can view how the palate moves as you talk. It will only take a few minutes.
When all the assessments have been completed, the team will review the results together so we can fully discuss treatment options with you.
If you or your child are worried or nervous about any of these investigations, please contact the team. We can have practice sessions to help you to feel confident or can get support from our Psychology team.
Members of the cleft team take part in a multi-disciplinary clinic at University Hospital of Wales, Cardiff, for people who have recently been diagnosed with 22q11 deletion syndrome. The purpose of this clinic is to give information related to the condition and ensure that you have been referred to all of the relevant Health Professionals to be able to support you.
22q11 Paediatric Service - Cardiff and Vale University Health Board
For more help and support on 22q11 please follow this link to the Max Appeal website.
Where surgery to improve nasal airflow in speech is not possible, you may be invited to attend a speech appliance clinic. A speech bulb or palatal lift is a device which is placed into the mouth which aims to lift the palate or fill a gap between the palate and pharyngeal wall to reduce the amount of air coming down the nose during speech. You will see a Speech and Language Therapist, Restorative Dentist and a Dental Technician at the clinic.
Further information about speech appliances can be found by following this link