[Factors of health formation in disabled children with congenital cleft lip and/or palate].

Objective: The aim of the study to determine the factors of health formation in disabled children with congenital cleft lip and/or palate.

Material and methods: The data of rehabilitation records and interviews with families raising 393 children with congenital clefts of the upper lip and/or palate aged 3 to 12 years were analyzed.

Results: Registration of disability status was untimely in 57.25% of children with congenital palate, in 12.05% of children with congenital cleft lip and/or palate, and in 11.46% of children with congenital cleft. The late registration of the relevant documents on the child's status in 3.56% of parents was influenced by reluctance to consider their child disabled for psychological reasons, in 9.16% of cases - by low qualification of a pediatrician/neonatologist, in 4.33% - by untimely diagnosis, in 65.9% - by ignorance of the possibility to register the disability status, in the remaining 17.05% of cases - by organizational reasons.

Among 61.83% of mothers in the maternity hospital there was no instruction and/or practical training in the peculiarities of feeding children with congenital cleft lip and/or palate. A fairly large percentage of children (47.8%) were transferred from the maternity hospital to the neonatal pathology department without vital indications due to the «impossibility» to organize their proper feeding. In the maternity hospitals of Donetsk Oblast, only 3 children out of 100 newborns with congenital cleft lip and/or palate were consulted by a maxillofacial surgeon during the analyzed period. The organization of rehabilitation of children with congenital cleft lip and/or palate in the pediatric area does not meet the standards. Only 46.06% of parents received specific and detailed medical and organizational recommendations from the pediatrician during the first week of the child's stay at the site. Children with congenital cleft palate were especially often out of the field of vision of both pediatricians and surgeons. Only 23% of children were examined by an oral surgeon in the first two months of life. 72.01% of parents were insufficiently informed on most of the issues related to treatment and rehabilitation of their child. 9.41% of the surveyed parents had no such knowledge. Only 76.08% of parents followed all or part of the recommendations of specialists on child care at home.

Analysis of the morbidity structure of children with congenital cleft lip and/or palate has shown that the first ranks, regardless of the type of malformation, are occupied by diseases of the blood and hematopoietic organs, respiratory diseases, diseases of the endocrine system, nutritional and metabolic disorders, and skin diseases. Congenital anomalies, mental disorders and psychotic states occupy a significant specific weight in the structure of morbidity of children with congenital cleft lip and/or palate.

Conclusion: The conducted research allowed us to identify a number of factors that have a significant impact on the quality of the treatment and rehabilitation process of children with congenital cleft lip and/or palate, and, ultimately, on their health: an integrated system approach, unified organizational principles in the activities of rehabilitation institutions; information and training of pediatricians in the treatment and rehabilitation work with children with congenital cleft lip and/or palate; organization and implementation of individual treatment programs for children with congenital cleft lip and/or palate; availability of a specialist-coordinator responsible for the course, quality, and outcome of treatment and rehabilitation of children with congenital cleft lip and/or palate.