Word on Health

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Word On Cleft Lip and/or Palate and Depression

Our grateful thanks to CLAPA for their help with this week's feature and for the use of the information below.  For more detailed information, help and advice please contact CLAPA on 0207 833 488.

Scroll down the screen for further information and links to support organisations on depression and mental health.

Cleft means 'split' or 'separation'. During early pregnancy, separate areas of the face develop individually and then join together. If some parts do not join properly the result is a cleft, the type, and severity of which can vary.

Cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the coloured portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides it is called a bilateral cleft.

A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts.

Cleft palate occurs when the roof of the mouth has not joined completely. The back of the palate (towards the throat) is called the soft palate and the front (towards the mouth) is known as the hard palate. If you feel the inside of your mouth with your tongue, you will be able to notice the difference between the soft and the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes a baby with a cleft palate may have a small lower jaw (or mandible) and a few babies with this combination may have difficulties with breathing easily. This condition may be called Pierre Robin Sequence.

How does it happen?  The cause of clefts is not understood very well. Whilst we know what happens, we do not know why. Sometimes clefts run in families and sometimes a baby is born with a cleft without anyone else in the family having one.

Who treats cleft lip & palate patients?  Treatment will be provided by a team of specialists working together to make sure that the best possible treatment is given. The specialists making up a team may include the following:

    * Surgeon
    * Cleft Nurse 
    * Orthodontist
    * Paediatrician 
    * Speech and Language Therapist
    * Psychologist
    * Geneticist 

The parents of a baby born with a cleft should be contacted by someone from the regional cleft team within 24 hours of diagnosis.

When is a cleft lip repaired?  A cleft lip is usually surgically repaired by the time a baby is 2-3 months old. It requires a general anesthetic and takes roughly one and a half hours. The surgeon re-arranges the skin and muscles of the lip so no skin grafting from other parts of the body is needed.

Most babies recover very quickly and will not experience much pain after this operation. Medication is given for any discomfort. The hospital stay for this operation is between 3 - 5 days. A parent is usually welcome to stay in a hospital with the child.

Feeding after the lip operation is not usually a problem. The nurse or the speech and language therapist on the cleft team will be able to answer any questions about feeding.

When is a cleft palate repaired? The palate is usually repaired by the time a baby is a year old. The tissues of the palate are re-arranged but no extra tissue from other parts of the body is used. The operation is, like the lip repair, carried out under general anesthetic and takes approximately one and a half hours.

What other operations may be necessary? Minor improvements to the lip or nose may sometimes be required. Sometimes these are done while the child is still very young and sometimes when the child is much older when they have stopped growing.

A few children may require an extra operation to improve speech by reducing the amount of air going into the nose.

A bone graft operation is now routine where there is a cleft that extends into the gum. This normally takes place when the child is 9 or 10 and will allow the second teeth to come through in the normal positions.

Other surgery to align the top and bottom jaws may occasionally be necessary. This is carried out when a child has reached his or her full growth at about 16 to 18 years of age. Speak to someone on your cleft team for further information.

Is speech development affected by a cleft lip? Children with a cleft lip or cleft lip and gum usually develop normal speech. In infancy, the child's communication skills are usually monitored by the speech therapist on the cleft team.

What effect is cleft palate likely to have on speech?  Following the repair of the palate, the majority of children develop good speech. However, a repaired cleft palate may make it harder for a child to pronounce some sounds clearly, and this may affect the quality of speech by giving it a nasal tone.

As a result, some children will need help from a speech and language therapist.

A few children require an extra operation to improve speech by reducing the amount of air going into the nose. In infancy, the child's communication skills are checked regularly so that advice and treatment can be given to overcome any problems as early as possible.

Does a cleft affect hearing? A child with a cleft palate may sometimes have hearing problems as a result of middle ear infections and catarrh. Fluid in the middle ear is often described as "glue ear" and is also quite common in children who do not have a cleft.

In infancy, the child's hearing is monitored carefully by an ENT surgeon. Regular checks are arranged as good hearing is needed for speech and language development.

If a child has frequent middle ear problems, surgery to the ear may be recommended. This may involve placing a grommet tube into the eardrum to allow air into the middle ear. This operation can significantly improve the child's hearing.

Do a cleft child's teeth develop normally? As a child's teeth are growing in the jaw at the time a cleft occurs, the normal development of some of them may be affected. This will depend on the type of cleft the child has. The teeth of children with clefts often come through a little later than those of children who do not have clefts.

If the gum is affected by the cleft, teeth near the position of the cleft may be missing, twisted or not the right shape. Sometimes extra teeth develop. The teeth in the top and bottom jaws may not meet together properly.

It is rare for any orthodontic treatment to be carried out on a child's milk teeth. When the permanent teeth come through a brace is usually needed to correct irregularities. It is important that children born with cleft lip and/or palate, just as others, should see a local dentist from an early age for regular check-ups. He or she will need to be happy about dental examinations. It is important that the teeth are well cared for with special attention to cleaning and avoidance of too many sweets and sugary or fizzy drinks.

For more information please contact CLAPA on 0207 833 4883 

DEPRESSION

What is depression? Depression is one of the most common conditions in the UK, affecting one in five people at some stage in their life. It is also one of the most misunderstood. The World Health Organisation estimates that by 2020 depression will be the biggest global health concern after chronic heart disease.

The word 'depression' is used to describe everyday feelings of low mood which can affect us all from time to time. Feeling sad or fed up is a normal reaction to experiences that are upsetting, stressful or difficult; those feelings will usually pass.

If you are affected by depression, you are not 'just' sad or upset. You have an illness which means that intense feeling of persistent sadness, helplessness, and hopelessness are accompanied by physical effects such as sleeplessness, a loss of energy, or physical aches and pains.

Sometimes people may not realise how depressed they are, especially if they have been feeling the same for a long time, if they have been trying to cope with their depression by keeping themselves busy, or if their depressive symptoms are more physical than emotional.

Here is a list of the most common symptoms of depression. As a general rule, if you have experienced five or more of these symptoms, for most of the day nearly every day, for over two weeks, then you should seek help.

  • Tiredness and loss of energy
  • Persistent sadness
  • Loss of self-confidence and self-esteem
  • Difficulty concentrating
  • Not being able to enjoy things that are usually pleasurable or interesting
  • Undue feelings of guilt or worthlessness
  • Feelings of helplessness and hopelessness
  • Sleeping problems - difficulties in getting off to sleep or waking up much earlier than usual
  • Avoiding other people, sometimes even your close friends
  • Finding it hard to function at work/college/school
  • Loss of appetite
  • Loss of sex drive and/ or sexual problems
  • Physical aches and pains
  • Thinking about suicide and death
  • Self-harm

Terms you might hear - everyone's experience of depression is different.  However, several specific types of depression have been identified.

Reactive depression - this type of depression is triggered by a traumatic, difficult or stressful event, and people affected will feel low, anxious, irritable, an even angry. Reactive depression can also follow a prolonged period of stress and can begin even after the stress is over.

Endogenous depression -  is not always triggered by an upsetting or stressful event.  Those affected by this common form of depression will experience physical symptoms such as weight change, tiredness, sleeping problems and low mood, as well as poor concentration an low self-esteem.

Manic depression (also known as bipolar depression)  - people with manic depression experience mood swings, with 'highs' of excessive energy and elation, to 'lows' of utter despair and lethargy.  Delusions of hallucinations can also occur. Most people with this condition have their first episode in their late teens or early twenties.

Seasonal affective disorder (SAD) - this type of depression generally coincides with the approach of winter. It is often linked to shortening of daylight hours and lack of sunlight. Symptoms will include wanting to sleep excessively and cravings for carbohydrates or sweet foods. Special 'light boxes' can be used to treat this kind of depression.

Post-natal depression - many new mothers will experience baby blues, mood swings, crying spells and feelings of loneliness three or four days after giving birth. Post-natal depression will, however, last for much longer and will include symptoms such as panic attacks, sleeping difficulties, having overwhelming fears about dying, and feelings of inadequacy and being unable to cope.

Post-natal depression is a common condition, affecting between 10% and 20% of new mothers. Starting two or three weeks after delivery, it often develops slowly, making it more difficult to diagnose.  Often it goes unrecognised by the woman herself, or by her family.

Treatments - treatment for depression can involve a variety of different approaches, including medication and talking treatments. Often people find that a combination of these works best.

Eight ways you can help someone with depression - you can help people experiencing depression, and in doing so you may even build a closer and more satisfying relationship with them. Remember though, that caring for someone with depression can be very frustrating and can also make you feel depressed. You may need support at times, too.

  • Remember that they cannot help being affected by depression.
  • Encourage them to talk and listen to what they are saying.
  • Let them know that you care about them.
  • Stay in contact with them. Send a card, give them a ring, visit them in their home.
  • Remember that depression can be a very isolating experience.
  • Help them to feel good about themselves by praising daily achievements.
  • Encourage them to help themselves by adopting self-help techniques.
  • Find out about support services available to them and to you (self-help groups, out of hours emergency support, helplines, see below).
  • Encourage them to visit their doctor, and ensure that they take any prescribed medication as directed.

Talking to someone who is depressed 

DO SAY

  • You're not alone in this.
  • You are important to me.
  • Do you want a hug?
  • You are not going mad.
  • We are not on this earth to see through one another but to see one another through.
  • When all this is over, I'll still be here, and so will you.
  • I can't really understand what you are feeling, but I can offer my compassion.
  • I'm not going to leave you or abandon you.
  • I love you (if you mean it).
  • I'm sorry that you're in so much pain. I am not going to leave you. I am going to take care of myself, so you don't need to worry that your pain might hurt me.

DON'T SAY

  • There's always someone worse off than you are.
  • No one ever said that life was fair.
  • Stop feeling sorry for yourself.
  • So, you're depressed. Aren't you always?
  • Try not to be so depressed.
  • It's your own fault.
  • I think your depression is a way of punishing us.
  • Haven't you grown tired of all this me, me, me stuff yet?
  • Believe me, I know how you feel. I was depressed once for several days.
  • Have you tried chamomile tea?

If they have suicidal intentions or have attempted suicide, call in other people (a GP, emergency services, social services) to help them and you with the situation. You can also contact The Samaritans (08457 90 90 90).

Reassure them that their life is important to you and to many other people and that they will feel better once they receive appropriate treatment. However hard it may seem to look after a person who is suicidal, the fact that you are showing you care will have a positive impact.

Further help and support

Depression UK a self-help organisation that helps people cope with their depression. www.depressionuk.org

Action on Depression is the only national Scottish organisation working with and for people affected by depression. www.actionondepression.org

Bipolar UK dedicated to supporting individuals living with bipolar, their families and carers. www.bipolaruk.org.uk

MIND provides advice and support to empower anyone experiencing a mental health problem. We campaign to improve services, raise awareness and promote understanding. www.mind.org.uk

Rethink Mental Illness help millions of people affected by mental illness by challenging attitudes and changing lives.  www.rethink.org

Mental Health Foundation is committed to reducing the suffering caused by mental ill health and to help everyone lead mentally healthier lives.   www.mentalhealth.org.uk

SYoung Minds is the UK’s leading charity committed to improving the emotional well being and mental health of children and young people.  ww.youngminds.org.uk

Stem4 is a charity dedicated to improving teenage mental health by stemming commonly occurring mental health issues at an early stage. www.stem4.org.uk

PANDAS Foundation offers support to families suffering from pre (antenatal) and postnatal depression. www.pandasfoundation.org.uk

All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.