Supporting a student with a cleft at school

Most students with a cleft need nothing special in the classroom. ACPA puts it simply: "In the classroom, a child born with a cleft should be treated like any other student," and "there is no connection between a cleft and a person's intelligence"^[1]. Still, a few things are more common for these students, and knowing about them early makes a big difference.

Speech

A child with a cleft palate may work with a speech-language pathologist (SLP). Their speech may sound like it comes out of their nose, and they may need help learning to make some sounds clearly^[2]. CLAPA's teachers' guide says about half of children born with a cleft palate have ongoing speech therapy, and around 40% of those still have speech that is "noticeably different" when they start school (UK figures, no date given)^[3]. Some speech patterns are learned habits that improve with therapy; others come from how the palate is built and works, and some children have more surgery to help with speech^[3][4].

• Be patient. Don't interrupt, finish their sentences or correct their speech in front of the class. Encourage them to use their voice and praise progress^[5].
• Reading aloud, presenting, foreign languages and wind or brass instruments can be harder. Offer alternatives when needed^[3][5].
• Find a low-key way for the student to leave for speech therapy, so they aren't singled out^[1].
• ASHA describes good therapy as a partnership between the school SLP, the cleft team and the family^[4]. If you notice a change, tell the family and the school SLP.

Hearing and ear infections

Children with cleft palate get ear fluid and infections more often than other kids^[2][6]. When infections keep coming back, doctors may recommend ear tubes, which usually fall out on their own between 6 months and 3 years after they're placed^[6]. ASHA notes that "fluctuating and long-standing conductive hearing loss is a primary concern" for people with cleft palate, and that even mild hearing loss can mean missing parts of fast conversation^[4]. Because hearing can come and go, a student may hear well one week and not the next.

• Seat the student close to you, with a clear view of your face^[1].
• Cut background noise where you can, use visuals, and have students take turns speaking in group work^[3].
• Watch for signs: not answering when their name is called, watching others before acting, or watching faces and lips closely^[3]. Let the family know, since hearing changes can come on slowly and the child may not notice^[5].

Learning

Most students with clefts do well in school, but as a group they face some extra risk. A 2014 study of Iowa students found that children with clefts scored about 5 percentile points lower than classmates, were about half a grade level behind, and had underachievement and special education rates 8 percentage points higher^[7]. ASHA also warns that misunderstandings about clefts can lead teachers to underestimate a student's ability^[4]. Hold the same high expectations. If a student is struggling, ACPA advises using the same referral process as for any student, and getting help "at the earliest possible age"^[1].

Time away for care

Students may miss school for appointments or surgery, even when they have no other needs^[5]. One common school-age surgery is the alveolar bone graft, which repairs the gap in the gum. CLAPA says it is usually done by age 12, and children usually need at least a week off school afterward^[8]. Orthodontic work can also mean regular appointments^[3].

• Plan catch-up work with the family before a planned surgery. ACPA notes teachers "may need to provide extra assistance" so the child doesn't miss key instruction^[1].
• Check that attendance awards don't penalize medical absences. CLAPA suggests rewarding improved attendance instead^[5].
• Help classmates welcome the student back, and follow the family's lead on what to say about the surgery.

Watch for teasing

Teasing is common. 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. Appearance and speech were the main reasons^[9]. A 2015 French study of 55 teens with clefts found 69% reported teasing at school, and 29% had at some point not wanted to go to school because of it^[10]. A 2017 North Carolina study found middle schoolers with clefts reported the most bullying^[11]. So stay alert through the transition to middle school, too.

1. Name it and stop it right away. Separate the kids, stay calm and talk with each child privately, not in front of others^[12].
2. Don't force an on-the-spot apology. Follow up with the student and tell the family^[12].
3. Use it to teach the whole class that everyone has differences. ACPA notes that "your positive modeling of acceptance will help shape how other students see a child born with a cleft"^[1].

If bullying targets a student's disability and creates a hostile environment, it may be "disability harassment," which schools must address under Section 504 and Title II of the ADA^[13].

IEPs and 504 plans (US)

Not every student with a cleft needs a formal plan. ACPA notes that classroom changes like seating can be made "through a 504 plan, through a student's IEP, or done informally"^[1]. When more support is needed, two federal laws apply:

• IDEA (an IEP). A student may qualify under categories such as "speech or language impairment" (including "impaired articulation" or "a voice impairment") or "hearing impairment," which covers hearing loss that is "permanent or fluctuating." In both cases the condition must adversely affect educational performance and the student must need special education and related services^[14]. A parent or the school can request an evaluation, which must usually be done within 60 days of parent consent, or the state's own timeline^[15].
• Section 504 (a 504 plan). This covers students with a physical or mental impairment that "substantially limits one or more major life activities." It can provide regular or special education plus related aids and services. Eligibility is decided case by case^[16].

The family's cleft team can often provide reports that help the school team decide.

Partner with the family

Ask how the student wants to talk about their cleft, and follow their lead. CLAPA suggests a meeting at the start of the year to cover^[5]:

• Words the student likes and doesn't like, and a simple explanation they use.
• What staff should say if a classmate asks or comments.
• Any speech or hearing concerns.
• Upcoming treatment or surgery.

Pass these notes on to next year's teacher, since information doesn't always follow the student^[5].