[Dysphagia] cleft palate quest.

[vbalmer at consolidated.net (Velvet Balmer)]

Joan, Suzanne, anyone?!?
(Ladies, I mentioned you specifically because I have your books and 
appreciate the wealth of information you have shared.)  First, the 
scenario:  15 mo. old with complete bilateral cleft lip and palate, 
surgical repair of lip  and second surgery at 9 mo of palate.  Surgery 
closed palate but not completely successful, two remaining holes and 
uvula that was formed is no longer present .  Child was not referred to 
OT or ST until now.  Significant oral hypersensitivity to temperature 
and textures as well as sensory issues with hands and head.  Lower  
extremity hypotonicity but trunk and pelvic support adequate for 
sitting without support.  Tongue retracted and thick.  Nasal emission 
of food and liquids.  Some coughing/choking during oral intake - no 
suck reflex after 9 mo. surgery, drinks from very soft sippy cup lid.  
Incomplete labial seal and weakness of lips.  No pitting of lips.  
Planned, but not yet scheduled surgery for alveolar ridge.  Questions:  
What, if any, course of action would you take to address the VPI prior 
to attempt to repair the palate?  Is advancing his diet something you 
would consider before next surgery (he eats pureed items with a couple 
of finger foods (crackers, animal crackers, etc.) but due to tongue 
retraction, tends to push food out of mouth and has poor bolus control. 
  Any other input you would have for me?
Thanks in advance for any input,
Velvet