Inside Pediatrics Summer 2022

Lip repair surgery is done when the molding is complete, often when the child is around 3 to 6 months old. It’s the same time frame for a child who didn’t use NAM therapy. “NAM doesn’t alter the time frame for lip repair,” said Dr. Kau. “The therapy coincides with the time when you are waiting for the baby to grow before surgery.” Crew had lip repair surgery in February 2022 with Dr. Grant at 5 months old. Jessica said she was full of mixed emotions the day of the two-hour surgery. “You wonder if you are doing the right thing for your child, but we were ready for the next step,” she said. Crew is scheduled for cleft palate repair surgery in July 2022 when he is 10 months old—an important milestone in speech development. Crew will have an additional surgery (an alveolar bone graft) around age 6 or 7 to close any remaining gap. And depending on the alignment and shaping of his nose as he grows, there may be an additional surgery—what surgeons call a “kindergarten rhinoplasty”— but time will tell. “His results are unbelievable. I’m glad we pursued it for Crew. For families considering NAM, I would recommend researching it, knowing that it really depends on what’s best for the family. Go with what works for you and your baby,” Jessica said. “Keep an open mind, because it is a lot of work. But it’s such a small window of time. If it helps at all, it’s worth a shot.” Dr. Kau said NAM works well for patients like Crew who have a bilateral cleft lip. “It requires perseverance, but the results are good. The Mitchell family was wonderful. They really stuck with the process,” said Dr. Kau.

professionals. If insufficiently treated, cleft lip or palate can cause lasting dental, nutrition, hearing and speech problems. “We see this frequently in international adoption cases. The proper surgery often didn’t happen when the child was younger, and it’s much harder to repair a badly repaired cleft,” said Dr. Grant. He recommends that parents seek out surgeons who routinely do this surgery and are affiliated with the American Cleft Palate Craniofacial Association (ACPA). The Cleft & Craniofacial Center at Children’s of Alabama is home to the state’s only ACPA- Approved Team for both cleft lip and palate and craniofacial procedures. In 2021, a generous donation from Mr. and Mrs. Bill Smith of Birmingham brought NAM therapy to Children’s of Alabama. NAM is not typically covered by private insurance, nor is it ever covered by Medicaid. The Smiths sought NAM therapy for their own daughter outside Alabama and were inspired to make this treatment possible for families to receive care in their home state. “The Smith gift makes NAM available to all without having to decide who can or can’t qualify for coverage,” said Dr. John Grant, who serves as the director of the Cleft & Craniofacial Center and Chief, Pediatric Plastic Surgery.

Since 2021, 30 patients have completed NAM and lip taping therapy at Children’s of Alabama.

For more information, visit childrensal.org/cleft-and- craniofacial-center

If a child has cleft lip or palate, it is extremely important that parents consult a team of experienced medical

NAM week 6

NAM week 11

Post Lip Surgery

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