Inside Pediatrics Summer 2022

How does NAM work? The Children’s of Alabama NAM team consists of an orthodontist, plastic surgeon and nurse practitioner who are specially trained in NAM therapy and the surgeries that follow. During and after the therapy, patients will also see other members of the craniofacial team at regular clinic visits as often as needed. • Initially, patients will be referred by their pediatrician or cleft care provider to the Cleft & Craniofacial Center, where the medical team will evaluate and offer NAM to patients who would benefit. NAM works to gently direct the growth of the baby’s gums and the shape of the nose during the first few months after birth, when these tissues are soft and easy to mold. • If possible, a prenatal consultation with the team before the baby is born is preferred to provide the opportunity for the best possible outcome. It allows an opportunity for the child’s condition and treatment options to be discussed and for the parent(s) to ask extensive questions and get to know the medical team before the baby is born. • Following the consultation and custom medical plan, the medical team will perform an initial scan of the newborn baby with digital or traditional equipment, depending on the child’s specific needs, ideally before one week of age. The NAM appliance is ready about one week later after the scan.

• Parents work directly with a Children’s orthodontist during NAM therapy. The orthodontist fits the baby with a custom molding plate that looks like a retainer someone would receive after braces.

• The baby wears the molding plate 22 to 24 hours a day, seven days a week, including when they are feeding. The plate is held in place using small rubber bands that are taped to the baby’s cheeks. The NAM team will teach parents how to change the rubber bands and the tape and clean the molding plate at home as needed (usually each day).

• Every one to two weeks for an estimated 12 weeks, the

orthodontist makes small changes to the shape of the molding plate to guide the baby’s gums as they grow. Each visit takes 40 to 60 minutes. Families will have regular visits over an estimated 12 weeks

• Once the gap in the gums is small enough, the orthodontist adds a post called a nasal stent with smooth, rounded plastic to the front of the molding plate. The nasal stent slides easily into the baby’s nostril. It slowly lifts up the nose and shapes the nostril on the side of the cleft. • Once the NAM process has been completed, the baby will have surgery to reconstruct the lip and further shape their nose. The NAM appliance is no longer needed after surgery.

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