A local perspective on the initial management of children with cleft lip and palate by primary care physicians

To evaluate the frequency and referral patterns, need for continuing education, and information given to parents of children with cleft lip and palate by local primary care physicians. A survey was sent to primary care physicians from the pediatrics, family practice, and internal medicine/pediatrics specialties in six surrounding counties of a regional craniofacial center located within northeastern Ohio with a population base of 1.5 million people. Particular aspects of care evaluated included protocols of care, information for parents, referral patterns, conferences attended, and literature read. Nearly 30% of physicians had standard protocols when children are born with clefts. Eighty-seven percent of physicians referred children within 2 weeks of diagnosis, yet only 48% gave referrals to a multidisciplinary team. Physicians providing team referrals were nearly three times as likely to attend related conferences and approximately four times as likely to have a set plan at the time of diagnosis of the cleft. Forty-nine percent of physicians gave oral information, 35% gave oral and written information, and 10% did not give parents information. Ninety-four percent of physicians gave parents the option to call with concerns. Pediatricians were approximately four times as likely to attend cleft conferences and desire continuing education updates. However, family practitioners were over three times as likely to give proper referrals, compared with pediatricians. There is a necessity to educate local primary care physicians who manage children with cleft lip and palate regarding cleft information for parents, referral guidelines, the cleft team concept, and the role of primary physicians.