Classroom guide: reading My Puzzling Smile

My Puzzling Smile was written by a kindergartner, with his mom's help, to explain to his classmates why he looked different, and that being different is okay. It was made for exactly this: a classroom.

Why a book like this matters

Clefts are not rare. According to the CDC (2026), in the US about 1 in 1,031 babies is born with cleft lip with or without cleft palate, and about 1 in 1,563 with cleft palate alone^[1]. Over a teaching career, there's a good chance you'll have a student with a cleft in your room.

Teasing is the main reason to talk about it early. In a 2006 study, 62% of children and young adults with cleft lip and palate said they had been teased or bullied, compared with 22% of a comparison group. Facial appearance (55%) and speech (34%) were the most common reasons^[2]. A 2017 UCLA study of 99 young people with craniofacial differences found that children aged 8 to 10 had the highest levels of anxiety, depression and peer difficulties, and the researchers suggested educating classmates about the condition^[3]. CLAPA, the UK cleft charity, notes that children may start to feel self-conscious about how they look from around age 6 or 7^[4]. So reading a book like this in the early grades comes at a useful time.

Before you read

If a student in your class has a cleft, talk with them and their family first. Some kids love to share; others would rather not be singled out. The American Cleft Palate-Craniofacial Association (ACPA) suggests meeting with parents to learn about the child's history, any planned treatment, and how they would like information shared with classmates. It also describes the classroom as "an opportunity for the other students to learn about facial differences," while respecting the family's wishes about privacy^[5].

• Ask whether the student wants to be involved (helping read, answering questions) or would rather just be part of the class.
• Ask what words the family uses, and any words they would rather you avoid^[6].
• Ask if the student has a short, simple explanation they like to use. CLAPA gives this example: "I was born with a hole in my lip and the doctors sewed it up when I was a baby"^[6].
• Share that explanation with other staff (recess, lunch, substitutes) so everyone responds the same way^[6].

If no one in your class has a cleft, the book still works. It's a story about difference, and every child has something that makes them different.

Simple facts you can share

Kids will ask questions. Keep answers short and true:

• A cleft is an opening in the lip, the roof of the mouth (the palate), or both. It happens when those parts don't join completely early in pregnancy. Doctors repair it with surgery, usually in the first year or so of life^[1].
• Some kids with a cleft get more ear infections, and some see a speech therapist to help with certain sounds^[1][7].
• "There is no connection between a cleft and a person's intelligence"^[5].
• A cleft is something a baby is born with. It isn't something you can catch^[1].

Discussion questions

• Why do you think the author wrote this book?
• How would you feel if you were new and looked different?
• What makes you different? What makes us the same?
• What could you say or do to help a classmate feel included?

Let kids answer in their own words. If a question comes up that you can't answer, it's fine to say "I don't know, but we could ask a doctor or a family who knows."

Activity: the "United by" wall

Each student finishes the sentence "I'm united with others by…" on a card. Put the cards together on one wall, with a gold line connecting them.

This fits what anti-bullying research says about prevention. StopBullying.gov notes that "peer support is an important protective factor against bullying," and describes one school where students "discovered things they had in common and formed friendships"^[8].

Keep it going after the book

• Build in belonging. StopBullying.gov suggests buddy systems and activities "in which everyone has a role to play"^[8]. Rotating group jobs means every student gets a turn to lead.
• Take care with some lessons. CLAPA flags that self-portraits, lessons about teeth and similar topics may need a gentle approach for a child with a cleft^[6]. A quick word with the family beforehand helps.
• Model it. ACPA reminds teachers that "your positive modeling of acceptance will help shape how other students see a child born with a cleft"^[5].

If a comment or teasing comes up

StopBullying.gov's advice for adults responding on the spot^[9]:

1. Intervene right away. It's okay to get another adult to help.
2. Separate the kids involved and make sure everyone is safe.
3. Stay calm, reassure the kids involved (including bystanders), and model respectful behavior.
4. Don't question children in front of others, and don't make them apologize or "make up" on the spot. Follow up with each child separately.

Afterward, let the family know what happened. For ongoing support, see our guide on supporting a student with a cleft at school.

Get copies

Request classroom copies through the request form. [printable PDF version TBD]