The Plan for the Next 18 Years
What is the staged plan of care for a child like Mateo, from birth through the teen years, and why is each step timed when it is?
💡 care is staged by developmental windows, not a random calendar, and someone has to hold the whole 18-year plan.
Prerequisite check
- compares how often both twins are affected; identical twins are about 60% concordant for nonsyndromic clefts versus about 5 to 10% for fraternal twins and siblings.
- That identical twins are far more concordant than siblings shows genes clearly matter, but not 100% concordance shows genes are not the whole story.
What you will learn
Goal: Students will order the major stages of care from birth through adolescence and explain why each is timed when it is, building Mateo's staged timeline.
- care is multidisciplinary (many specialists as one team) and staged (a timed sequence, not all at once), forming a from birth into adulthood.
- Feeding comes first (birth to 3 months); lip repair is around 3 months; cleft repair is around 9 to 12 months, timed before the toddler speech window.
- Ear tubes and hearing checks run through infancy and childhood, and they protect speech because chronic ear fluid can harm hearing, which harms speech.
- and orthodontics come in (about 7 to 11 years), with definitive orthodontics, jaw surgery, and revisions in adolescence into adulthood.
Model: The cleft care timeline (out of order) and two timing clues
Real stages of multidisciplinary care, shuffled on purpose for the team to order. Card A: orthodontics and (filling the bony gum gap), about 7 to 11 years, to align teeth and close the gap in the tooth-bearing ridge. Card B: cleft lip repair (), about 3 months (within the first year), to restore lip and nasal form. Card C: feeding support and positioning, optional presurgical molding, birth to about 3 months, to keep the baby fed and growing and narrow the cleft before surgery. Card D: definitive orthodontics, jaw surgery, rhinoplasty, scar revision, adolescence into adulthood, to correct and finalize function and appearance. Card E: cleft repair (), about 9 to 12 months (within 18 months), to separate mouth and nose and enable normal speech. Card F: speech-language therapy and velopharyngeal checks, toddler years onward, to prevent and treat hypernasal, unclear speech. Card G: ear tubes and hearing checks (ENT and audiology), infancy through childhood as needed, to treat chronic ear fluid and protect hearing.
Two timing clues: babies grow fastest and feed most in the first months, so feeding cannot wait, but the lip and tissues are tiny and still developing, so surgery is staged into the first year and beyond; and children begin forming real words in the toddler years, so a palate that still leaks air into the nose during that window will shape unclear speech habits that are hard to undo later.
Explore (work the model before reading on)
- Read the seven cards. Which one has the earliest age, and which one has the latest?
- Which two cards are the surgical repairs of the itself (the lip and the )?
- Put cards A through G in time order, youngest age to oldest. Write the sequence of letters.
- Using the timing clues, explain why repair (card E) is scheduled around 9 to 12 months and not, say, at age 5. What does the toddler speech window have to do with the timing?
- Predict what could go wrong if the team skipped the ear and hearing checks (card G) during infancy and childhood. Connect a hearing problem to a knock-on effect on speech (card F).
- In one sentence, what pattern did your team find about how the stages of care are arranged?
Guided notes
Multidisciplinary, staged care
- care is multidisciplinary (many specialists working as one team) and staged (a timed sequence, not all at once).
- The order is driven by developmental windows, the ages when the body is ready for or in need of a given step.
The first-year sequence
- Birth to 3 months: feeding and growth come first (card ____); about 3 months: lip repair restores the lip and nose (card ____).
- About 9 to 12 months: repair, timed before the toddler ______ window so air stops leaking into the nose as the child starts talking (card ____).
Childhood through adolescence
- Toddler onward: speech therapy (card ____); across childhood, ear tubes and hearing checks, because ear fluid can harm hearing and, in turn, speech (card ____).
- About 7 to 11 years: orthodontics and (card ____); adolescence into adulthood: final orthodontics, jaw surgery, and revisions (card ____).
Reading the Research
- Skim the title and abstract first to get the gist.
- Circle the one sentence that states the main claim.
- Box the evidence the authors give for that claim.
- Mark one sentence that confuses you, and move on.
Vocabulary (the same words your classes use)
Vetted readings for this lesson
- Vyas T, et al. 2020. Cleft of lip and palate: A review. J Family Med Prim Care. [PMID:32984097]
- James JN, et al. 2014. Management of cleft lip and palate and orthognathic considerations. Oral Maxillofac Surg Clin North Am. [PMID:25438882]
- Dean KM, Leeper LK. 2020. Management of submucous cleft palate. Curr Opin Otolaryngol Head Neck Surg. [PMID:33105231]
Track your progress today
Check these off as you work through the lesson, then submit. This tells Mr. Mendoza how you're doing so he can help the class. It does not replace turning in your producible.
Use the code Mr. Mendoza gave you, not your name. Saved on this device.
- Read the Model and answered the Explore questions.
- Filled in the guided notes in my own words.
- Defined the new vocabulary with an example.
- Built the producible: Lay out Mateo's roadmap as a simple timeline with the seven stages in order, each with its age and a one-line 'why now,' then circle the two stages you would explain to the parents first this week and write one sentence on why those two are the most urgent right now.
- Wrote my Claim, Evidence, and Reasoning exit ticket.
Exit ticket (Claim, Evidence, Reasoning)
- Claim: The order of Mateo's is set by ________ (random scheduling / the child's developmental windows).
- Evidence: For example, repair is timed at about ________ months, placed before the toddler ________ window.
- Reasoning: Care is staged this way because ________, which is why a coordinator is needed to hold the full 18-year plan.
| Criterion | Proficient | Developing | Beginning |
|---|---|---|---|
| Complete | Every required part of the artifact is present and filled in. | Most parts are present, but one is missing or left blank. | Several parts are missing. |
| Accurate | The science and data are correct and match the evidence. | Mostly correct, with a small factual slip. | Key science or data is wrong. |
| Scientific reasoning (CER) | States a claim, backs it with specific evidence, and explains the reasoning. | Has a claim and evidence, but the reasoning is thin or missing. | Gives an answer with no evidence or reasoning. |
| Professional communication | Clear, organized, and labeled the way a clinician or scientist would write it. | Readable but disorganized or missing labels. | Hard to follow. |
| Submitted | Turned in the right way (Schoology for routine work) and confirmed. | Turned in, but in the wrong place or unconfirmed. | Not turned in. |
- CompleteProficient: Nothing is left blank: the model fills every part of "Lay out Mateo's roadmap as a simple timeline with the seven stages in order, each with its age and a one-line 'why now,' then circle the two stages you would explain to the parents first this week and write one sentence on why those two are the most urgent right now.".
- AccurateProficient: Every number and claim matches the case evidence.
- Scientific reasoning (CER)Proficient: It names a claim, cites the specific evidence, and explains the reasoning, not just the answer.
- Professional communicationProficient: It is organized and labeled like a real chart note.
- SubmittedProficient: It would be turned in on Schoology and confirmed.
Where this leads: careers
What's next: We have an 18-year for Mateo, but what do the operations on that plan actually fix? What do the surgeries accomplish clinically?