Re:Erkkila et al.: Association between School Performance, Breast Milk Intake, and Fatty Acid Profile of Serum Lipids in 10-Year-Old Cleft Children. J Craniofacial Surg 2005;16:764-769
Once again, conscientious outside-the-box-thinking by our colleagues from Finland has opened doors and expanded avenues for research into concerns that continue to arise in the transdisciplinary care management for patients with various lip and palatal clefts. Concern for early nutritional experiences and cognitive development continue to hold the attention of cleft palate teams around the world. This study offers documentation that nutritional intake and physical growth of 0- to 3-month-old babies comprises more than evidence of the ability of those little bodies to heal the wound created by early surgical closure of the cleft. This study also indicates a nutritional advantage during a critical window of time for regulation of the child's biochemical system,s with implications for development of the infant's plastic nervous system.
In addition to the authors' stated interest in replication/confirmation of these data, this study suggests other areas of inquiry, including (1) does the 1 year of age cleft closure schedule impose unwarranted duration of oral feeding problems; (2) what were the effects, if any, of maternal mental health, attitudes toward producing breast milk, or fatigue; and (3) does language acquisition alone provide sufficient evidence of cognitive development?
It would be of interest to know what, if any, early special stimulation efforts were programmed into the daily routines of these patients. Also, the reader is curious to know if the language disorders identified in this study may have been related to early peripheral hearing problems or to neurologic variants of central auditory deficits. The authors have elicited an exciting array of thoughts related to children with cleft lip and palate. Their evidence furthers the belief that the disfigurement by the orofacial cleft condition may distract health care personnel and parents from the complex ramifications of the birth defect.
Jane Scheuerle, PhD
Tampa Bay Craniofacial Center, University of South Florida, Tampa, FL 33603, USA