We just went to our six-month craniofacial clinic on Thursday where I was better prepared to ask more specific questions (as opposed to when Alex wasn't quite 4 weeks old). Our plastic surgeon was there, who is fabulous. He's hailed as one of the greatest cleft surgeons in the country and yet is one of the kindest doctors I've ever spoken with. He also is just crazy about Alex - perhaps because Alex is presenting as such a challenge with the extreme width of his cleft causing an odd anatomy, as well as his intense scarring, though maybe just because Alex is such a great kid. I asked him about Alex having trouble with solids - how he can't seem to figure out how to properly move them from the front of his mouth to the back, but also said I wasn't that concerned as he's getting EBM & that's working out okay (thought sometimes he goes through growth spurts which depletes our supply). I asked if he was having trouble because of the cleft or if maybe it was because of the Haberman nurser he uses which doesn't require him to suck or do much of anything to swallow except chomp on the nipple. He said it was probably a combination of the two, but that with practice Alex will be able to overcome it. He also said - and for this he shut the door - that his own youngest son didn't eat solids hardly at all for a year and a half, but just drank breastmilk and that he felt this was just fine. I was so thrilled that he said this b/c it reinforced the fact that I like this guy. It's not often that you get a health professional telling you that exclusive breastfeeding is okay past six months, let alone for a year!
Immediately after this conversation, however, I met with the dietician who told me that I wouldn't be able to keep him supplied with milk and that there's a "window of opportunity" that I need to take advantage of or else he'll - I don't know what exactly, I guess NEVER eat solids! I immediately quit arguing with her when she told me I wouldn't be able to keep my supplies up to satisfy him. I couldn't believe her! It's no frigging wonder women have "supply" problems in this country - nurses/health professioinals are
telling them they have them! Well I don't
need to be told. I know just fine how to increase my supply if need be, thank you.
We talked also with the orthodontist & dentist who were just about useless yet again, even though I was armed with my questions. I wanted to know about what would be done for Alex's missing section of gum and what kind of orthodontia he might need. They said that they didn't know. Now, I can respect that they don't know how his teeth will grow in, but they could at least give me some kind of idea - like what happens in circumstances like this with other kids, or what could potentially happen even. So I asked. They said that he'll probably have an orthodontic evaluation between 6 and 8 - when adult teeth are coming in - and that he might need some orthodontia to expand his palate some. So I wondered about braces. They again said they didn't know. I said that I'd heard of kids needing braces for years on end to correct their teeth. They said that he'll probably need some sort of orthodontia, but they didn't know what. So I asked what would be done for the missing teeth - they said nothing. Which sort of bothers me. They said that nothing will be done until the jaw is done growing when he'll get maybe a bridge or an implant. So Alex has to go his entire childhood with missing teeth, possibly into his early twenties. They were pretty adamant, however, about me cleaning his gums after every feeding with this new Gerber product to avoid bottle rot or whatever it's called. I pretty much decided to ignore that. I guess they don't think I have enough to do that I need to clean his gums after every feeding so he can get used to the sensation for when he has teeth to actually clean. Please somebody tell me that I'm not insane for thinking this is utter BS! I also pretty much decided as they were talking to follow the advice of my plastic surgeon to find a good, perhaps KIND orthodontist when the time comes.
The Speech Therapist was useful however. She said that he probably will have some trouble with plosive sounds like 'Baa' and 'Paa', but that she was impressed with what he was doing so far. Looks like he'll need agressive speech therapy, but we have to see how he's doing in the fall before embarking on anything specific. For now it's up to me to get him talking the same way that other parents get kids to talk.
Alex also had his hearing tested and he passed! So the ear tubes are working and he can hear just fine! Permanent hearing loss isn't something that really goes hand-in-hand with clefts, but when your eustachian tubes don't work, fluid builds up and you can't hear & Alex hadn't had a good test since getting the tubes back in November.
I was also able to ask the Ear, Nose & Throat doc about the proper functioning of his eustachian tubes and he said that around eight years of age kids get about the best function out of them as they can, so that's the age to really discover if he's going to continue to require tubes or not. He said he may only need the one set, or maybe just a couple, depending on how well the muscles begin to function.
I told the nurse who organizes the specialty clinics that she could provide my name & number to families with new babies with clefts, so I might be getting some calls here. I said that I wasn't an expert, but then one of the other nurses chimed in and said that I was. From what I can tell, families who go through it are the best people to talk to about what to expect. So far we've been lucky with the day to day care of Alex, but we've had it rough during his recoveries. Hopefully this next recovery will be short. Our surgeon has decided to hold off on another lip repair until Alex is three or four to give it some time to loosen up on it's own. It doesn't look as though the lip revision made a significant change to his scar so far. The doc wants me to massage the scar but Alex just screams bloody murder whenever I try.
So I guess that's enough update for the moment.
