When Cleft Lip and/or Palate and Antenatal Opioid Exposure Intersect: A Tutorial

Abstract

Purpose: A new clinical subpopulation of cleft lip/palate (CL/P), which includes infants and children antenatally exposed to opioids, is increasingly appearing on CL/P teams and speech-language pathology caseloads. The purposes of this tutorial are to describe neonatal opioid withdrawal syndrome (NOWS), to offer a review of the NOWS feeding and neurodevelopmental outcomes literature, and to discuss the clinical and research implications for this new clinical population. Conclusions: Recent literature has pointed to a higher prevalence of CL/P in infants with NOWS, as compared to the live birth population. In addition to the typical feeding problems of infants with CL/P, other challenges emerge during the first several days of life for opioid-exposed infants in the neonatal intensive care unit (NICU). These feeding problems are characterized by disruption of the suck–swallow–breath process and are further complicated by the infant's state during withdrawal from opioids. There are trends across studies that suggest good reason for concern about adverse neurodevelopmental outcomes in opioid-exposed children. This includes evidence that children post-NOWS are at greater risk than children with typical development for speech; language and literacy impairments; and/or other cognitive, sensory, and behavioral problems. Children with CL/P already are at risk for speech, resonance, language, and feeding disorders. A history of antenatal opioid exposure may increase and add further complications. The SLP plays a key role in the management of and attitudes toward children with NOWS and CL/P in the NICU, on CLP teams, in early intervention, and in schools. This tutorial provides clinical guidelines for intervention with this new and growing population.