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Clinica Asturias, the hospitalToyos, Honduras and the 2011 Mission

Providing Speech Therapy and Feeding Management: My Thoughts & Experiences

By Ruth Trivelpiece, MEd

World Pediatric Project has traveled to Toyos, Honduras for over 10 years, providing care for children with cleft lip, cleft palate, ear malformations, and other pediatric surgical needs. In 2010, the organization initiated a speech therapy program to introduce post-operative speech services to children who received treatment for congenital conditions that affect speech, such as cleft lip and palate. hospital waiting roomI was honored to be invited to join the mission due to my expertise in the area of speech and feeding of children with craniofacial differences.

This second visit in 2011 offered me the benefit of following up with patients and their families from last year. I loved hearing how families followed through on my suggestions from last year. One six year old boy had an unrepaired cleft palate which, for safety measures, needed to wait until 2011 for his surgery. He and his family practiced the speech exercises I gave them while waiting to receive the surgery, which contributed to a better outcome. I really enjoyed recognizing and reconnecting with my patients and their families from last year's mission.

The busy days and the many patients receiving speech evaluations, feeding instructions and parent education consultations made my time at the clinic fly!

Speech Therapy

speech therapy photoOn the first day I screened 22 children for their speech needs and scheduled for the upcoming week those that would benefit from speech therapy. Using picture flash cards, exercises, and encouragement, I evaluated the kids and set up home programs for parents to work with them in order to maximize the benefit of their surgery.

Other appointments were made with  families while their children were at the hospital to review speech and feeding guidelines and techniques for their children’s post-op therapy. Therapy sessions were conducted one-on-one and parents were taught to act as their child's "mini speech therapist" to continue working on their child’s speech at home. Strategies were provided to help them communicate more effectively and guidelines developed to stay on track for their age. The opportunity to follow-up with my patients from last year's therapy was very valuable. It was great hearing how families had continued with the exercises to help their children.

One little boy with cleft palate, Luiz, was particularly inspiring because of how hard he would work in therapy. Ruth with Luiz, flash cardsHis speech was so severely impaired he could not be understood. We had to start at the most basic level to teach him to make many speech sounds. He would get frustrated because he wanted so badly to talk and be understood. Little by little he began to make some gains. Thank goodness for coloring books, silly bands and stickers! I think if he could get regular speech therapy he would show continuous progress. It saddened me to know that there were no speech therapists in the area to continue my work.

 

Feeding Instruction

Demonstrating proper position for feeding babyOne of my objectives was to focus on instructing families how to feed their babies with cleft lip and palate and provide more services toward patient care in order to optimize nutrition. This included providing feeding evaluations, introducing special bottles designed for feeding babies with cleft lip and/or palate, and demonstrating and instructing families on how to feed their baby, both pre- and post-op.

I was able to take the time to explain to mothers about the difficulties of breastfeeding and how difficult it was for these babies to gain weight. I had different bottles with me which help babies with clefts feed more efficiently, and I was able to show the families how much easier it was their babies to take milk from these special bottles. The families were given a supply of these bottles to use with their babies. I wondered if these moms would continue with my recommendations or if they would go back to their old ways. At first, all were afraid to give the bottle to their babies post-op, but once I demonstrated how to feed them the moms weren't afraid to try and all babies took to the bottle fine. I'm so glad I brought the bottles!

mom feeding babyThe most rewarding experience was when I evaluated the feeding of a three month old baby with cleft lip and palate.  He was so tiny and frail only weighed 3.5 kg—the mom was trying to feed her baby using both breast and bottle and she spent most of every day working on feeding him. Using the special Pigeon bottle, the baby fed  with great success and the mom was ecstatic. I explained to her about the problems with breast feeding and offered a plan to bottle feed 3 ounces within 20-30 minutes and then put baby to breast for skin-to-skin contact. Both were happy and I gave a supply of bottles and nipples to take home.

Many families were afraid to feed their children after surgery. I was able to spend time with the families during rounds with the surgeons, and offer support, encouragement and assistance to make this challenge a little easier.

End of This Year's Mission

Ruth and friendAfter a fulfilling but exhausting week of working with the children and their families each day, my last day was spent going over speech and feeding instructions during the doctor's rounds, checking on the kids in the wards and helping to pack up supplies—homeward bound. This year, I gave away all of my materials and supplies to the families that worked with me. I was talking to one of the mothers and encouraging her to read or look at pictures at home to practice her son’s newly acquired speech sounds. When she told me they didn’t have any books at home I gave her the rest of my therapy pictures and materials. Next year I’m bring more books to give to the children.

In the future, I would like to identify and train someone in the community to demonstrate, instruct and provide  feeding  assistance to families with children with cleft lip and palate. In addition, I'm hoping my speech therapy patients continue to practice the exercises and communication techniques I've taught them in order to continue their improvement.

team photo

 

 

 

 

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