and the 2011
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. I was honored to be invited to join the
mission due to my expertise in the area of speech and feeding of children with
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
The busy days and the many patients receiving speech
evaluations, feeding instructions and parent education consultations made my
time at the clinic fly!
On 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. His 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.
One 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!
The 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
After 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
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.