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Clinical psychology for a cleft lip and / or palate

What we do
How to access the service
Talking to your child about their cleft
Coping strategies for surgery

What we do

Clinical psychologists work with people with all sorts of conditions.

Being born with a cleft lip and / or palate does not necessarily mean life will always be hard or you are guaranteed to experience psychological difficulties. However, living with a medical condition such as cleft can bring challenges. We therefore like to meet all children and parents who are known to the cleft service at some point.

We will be very happy to discuss any questions or concerns you may have. We want to support you in any way we can and this support will look very different for different people.

The Cleft Clinical Psychology service has three main aims:

  1. To support the mental wellbeing and promote resilience in all children and families born with a cleft.
  2. To provide psychological therapeutic intervention where children or families are experiencing difficulties.
  3. To support children and families as they make their way along the care and treatment pathway.

Our work may include: 

  • support for you and / or your family as you make decisions around surgery, as well as support when preparing for surgery
  • support for you and / or your family when someone is living with a visible difference (for example, dealing with other people’s comments and questions)
  • helping people adjust to change (for example, after surgery, a medical diagnosis or school move)
  • therapeutic support for a wide range of mental health challenges, such as low confidence, anxiety and low mood
  • advice to promote general mental wellbeing

How to access the service

If you would like an appointment for yourself, your family or your child, please contact us through the Cleft Team and they will pass on your query:

  • Pamela Larmour, Cleft Coordinator: 073 8543 0707
  • Paula McCord, Assistant Cleft Coordinator: 028 9504 5952

Alternatively, you can mention it to one of the Cleft Team when you come to a clinic.

Talking to your child about their cleft

Many parents wonder how open they should be with their child when it comes to their cleft lip and / or palate. We usually remind parents that children can be extremely perceptive. They will probably pick up how you feel about their cleft from how it is discussed at home.

Your child (and any siblings) will form their own feelings and attitudes to having a cleft based on the approach their parents take to the condition.

For example, if parents approach their child’s cleft with acceptance, the child is likely to adopt these feelings as well. This will help normalise the child’s situation and influence how they feel and respond to questions and comments about their cleft. We can provide a space to allow you to process your own feelings about your child’s cleft should this be helpful.

It can also be beneficial to:

  • emphasise the importance of qualities beyond physical appearance
  • describe cleft-related treatments as ways to improve quality of life rather than to ‘fix’ something that is wrong

For example, you might explain speech and language therapy to your child as something that will help them feel confident in communicating their needs, thoughts and feelings to other people.

In many cases, an open and honest approach can help your child accept their cleft and everything that comes with it.

What should I say?

Use neutral or positive language that is appropriate for your child’s age. This can help prevent distress arising from confusion or misunderstanding.

Reassure your child that they will be well looked after as they grow and will not have to deal with their cleft alone. They will have family, friends and specialists in the hospital to help them live life to the full.

The CleftProud website has photographs and stories of people from around the world who were born with cleft lip and / or palate. As your child gets older, it may help to show them resources like this so they can see they are not alone.

Explaining the cleft to others

At some point, your child may be asked questions by others. This may happen more often for children with visible or speech differences. Reassure your child that most people who ask questions are simply curious and want to learn more about them. You and your child can develop a simple response to questions, for example:

I was born with a hole in my lip, but the doctors sewed it up and I’m fine now.”

“I was born with a small hole in my mouth so I sound a bit different.”

This will help your child feel more confident about facing questions, which will be especially important when they start school. Children tend to be very accepting and it is likely that many will drop the subject when they have received a brief explanation.

You can also download the ‘Moving Up’ leaflet, which has information to help with the switch from primary to secondary school.

Explaining hospital appointments

It is usually helpful to explain to your child exactly what the appointment is for in language they will understand.

Remember to explain that the appointment is for their benefit, both now and in the future. Let a member of the Cleft Team know if you are worried about your child’s anxiety when coming into hospital.

Although it’s important to talk to your child about their cleft, it’s also important to remember that their life will be full of challenges and achievements that have nothing to do with their cleft. Having a cleft is only one small part of who they are and many people with a cleft live full and happy lives.

Explaining surgery, including alveolar bone graft (ABG) surgery

Surgery can be a nerve-wracking experience for anyone, especially children. You can download this booklet to help prepare your child for coming into hospital.

It’s important to talk to your child about surgery and make sure their questions are answered. Common questions include:

  • How long will I be in hospital?
  • How long will I take to recover?
  • Will it be painful and for how long?

In the case of alveolar bone graft (ABG) surgery, it will be important to help your child understand why they will have more than one incision site and the reason for the bone graft.

You and your child will usually have an opportunity to discuss the procedure with the surgeon in a meeting beforehand. Write down any questions or concerns you have before this meeting.

Make sure your child leaves the meeting with an understanding of:

  • what will happen on the day
  • why the procedure is happening
  • what to expect during the recovery period

Reassure your child that the doctors and nurses involved in the surgery and recovery are very well trained and know how to look after them.

If your child is extremely nervous or afraid of a procedure, ask the Cleft Team for some help from the Clinical Psychologist.

It is also important that you feel calm and positive about the operation as your child may pick up on any nervousness. If you have any queries or concerns, ask the Cleft Team for help.

Coping strategies for surgery

Before surgery, it can be helpful to teach your child simple relaxation techniques to help them manage their anxiety.

  • Distract your child and keep them engaged in activities that are part of their normal routine. This is a good way to stop them thinking too much about the operation and becoming anxious.
  • Controlled breathing and calming images can help us feel in control. Specific breathing exercises for children and young people are widely available online or from the Clinical Psychologist. These exercises can also be useful in the recovery period after surgery.

If your child has something specific that makes them feel confident, like pretending to be a fictional character, you can focus on this. It may help your child feel like they can handle anything.