For a basic guide to cleft lip and palate at school, check out our leaflet ‘Children Born With Cleft Lip & Palate: The School Years’.
It is important for teachers to keep in touch with the parents of children born with clefts who may be unwilling to speak up for fear of being labelled “over anxious”. By understanding the condition and the issues it may cause in school life, it will be easier for teachers to give their pupils the support they need to flourish.
What issues can come up?
Medical appointments and surgeries
These may cause children to miss school and fall behind on subjects. Scars or differences caused by any surgery or orthodontic work can make children anxious about the reactions of others.
What can be done: If teachers can be informed about medical appointments, they can be aware of changes that are likely to occur which may affect the child at school. Children may be especially vulnerable at the beginning of a new school year, when the school, teachers and classmates are unknown quantities, and before and after operations. If a child can be helped to catch up on missed work they will be less anxious about falling behind. Try to keep in contact with parents/carers and if possible get a schedule of expected absences ahead of time so you can plan sessions with the child to catch up on missed work, or even prepare work in advance.
Children born with a cleft palate are more likely than other children to suffer from glue ear. This is usually temporary and can be treated, but hearing problems may continue for some time and may not be immediately obvious. Any hearing loss, even if it’s temporary, can make things very difficult for a child, both when it comes to hearing what the teacher says and in coping during noisy break times.
What to look out for: A child who does not seem to be paying attention or whose comprehension levels seem low may be having hearing issues, even if they are not aware of it themselves. Very young children may try to attract attention to themselves in an effort to be involved, such as making physical contact in order to see people’s faces and lip-read. A struggle with language acquisition and communication abilities may indicate hearing difficulties.
What can be done: Remember that hearing loss is often intermittent so a child’s ability to hear may fluctuate. Make a special effort to ensure the child is able to listen and pay attention, and give special consideration in cases such as exams where a tape recording or other spoken instructions are used. Reassure the child that if they have any trouble hearing they should say so immediately, and that by doing so they aren’t ‘causing a fuss’, they are helping you teach them better. If hearing loss is a known issue with the child, keep in contact with their parents/carers to make sure you are made aware of any changes that will affect their teaching.
Children born with a cleft sometimes have difficulties in making certain sounds, and their voices may sound slightly nasal. Volume control may also be a problem if a child has hearing issues.
What to look out for: Sounding different may make a child feel very self-conscious about speaking. This can affect class participation and how a child behaves with other children. If a child finds it difficult to make themselves understood, they may use physical contact to communicate and in an effort to be included in peer groups. It may also affect a child’s ability to learn a new language, as they may not be physically able to make some of the sounds.
What can be done: Be patient and encouraging, and asks the child’s parent/carer if there is anything in particular you or the school can do to encourage the child to be more confident in their speech, such as giving them a positive environment in which they can practice reading aloud. Be aware that a child may need to take time off of school to attend speech and language therapy sessions, and be prepared to help them catch up on any work missed. Special considerations may also need to be made for oral examinations.
Psychosocial Issues and Self-Esteem
A child born with a cleft lip and/or palate will differ from other children physically only in very minor ways. However, he or she may be sensitive to small differences in appearance, speech and hearing, and may therefore be in need of a little extra support to be able to flourish. They may have low expectations of themselves and believe that others do too. This can affect class participation, social behaviour and academic performance.
What to look out for: Poor academic and social achievement could be linked more closely to low self-esteem than to ability. Children may be withdrawn or anxious and be reluctant to participate in class. When it comes to socialising, it is sometimes difficult for children to tell the difference between genuine curiosity, friendly teasing and deliberate cruelty. A child may be the victim of bullying or they may just find constant staring and questions upsetting.
What can be done: Help the child to recognise their abilities and give them encouragement. Children often become aware of an ability for the first time by having it named and being able to talk about it (whether it’s obvious like drawing or less tangible like being ‘enthusiastic’) and this can be a huge confidence boost.
When it comes to staring and teasing, it is not helpful to minimise or dismiss a child’s hurt feelings, but it can be helpful to encourage them to think about where these feelings come from. It may be that the child is very sensitive about how they look, for example, and so will see any reference to looking or sounding different as something to be upset about. If on the other hand they are confident about their differences, they are much less likely to see these comments as an attack. It is also very normal for other children to be curious and to stare or make comments when they first meet someone whose face or speech is affected by any difference such as a cleft. It can be helpful to explain to the affected child that there is nothing they can do to stop this, but that there are lots of ways to cope with it, such as having a simple explanation ready in case anyone asks, or to change the topic if they find it uncomfortable.
Children usually react to the unknown out of fear and embarrassment. Name-calling and teasing can often be dealt with by simple explanations of the cleft child’s condition. If this is done on an occasion when the child is away from school, the teacher will have the opportunity to explain to the class that the child is brave and courageous. Helping the class to explore how they would feel if they had to cope with frequent hospital appointments as well as several homework assignments a week could be productive. We have a number of presentations under the ‘Resources‘ section that could be helpful.