It is important for teachers to keep in touch with the parents of children born with clefts who may be unwilling to speak up for fear of being labelled "over anxious".

If teachers can be informed about medical appointments, they can be aware of changes that are likely to occur which may affect the child at school. Children may be especially vulnerable at the beginning of a new school year, when the school, teachers and classmates are unknown quantities, and before and after operations. If a child can be helped to catch up on missed work he will be less anxious about falling behind.

Speech and hearing

A child born with a cleft may sufer intermittent hearing loss usually as a result of glue ear.Reduced attention span, repeated questions, deterioration of quality of speech and in work standards may well be signs of hearing loss.

Extra encouragement may be needed if a cleft child is to talk in front of the class, to participate in debates, read aloud or take part in video filming. In some cases special consideration may need to be made when the child is a candidate for oral examinations.

Teasing

Children usually react to the unknown out of fear and embarrassment. Name-calling and teasing can be dealt with by simple explanations of the cleft child's condition. If this is done on an occasion when the child is away from school, the teacher will have the opportunity to explain to the class that the child is brave and courageous. Helping the class to explore how they would feel if they had to cope with frequent hospital appointments as well as several homework assignments a week could be productive.