Inside the First Cleft Nutrition Training in Central America

The moment a baby is born with a cleft palate, the clock starts ticking. Babies with clefts are at a much higher risk of malnutrition than their peers, and may require specialised feeding counselling and support to avoid becoming severely malnourished.

A 2021 study commissioned by Smile Train found that, globally, more than 46,000 children under five died of cleft-related malnutrition between 2000 and 2020.

The crisis of nutrition for babies with clefts is particularly acute in places where even children without clefts often go hungry. In Guatemala, the UN estimates that half of all children will experience developmental delays or stunted growth because of malnutrition. The struggles are exponentially worse for babies with clefts.

For Smile Train, these facts made another one crystal clear: We needed to get these babies the urgent nutritional support they require at the soonest possible time so they could not only survive as babies but go on to thrive in school as children , provide for their families as adults, and otherwise fully live out their days.

In other words, we needed to restart the clock.

Thankfully, we already knew how. Since our founding 25 years ago, Smile Train has been equipping healthcare professionals in historically marginalised regions with the tools and training they need to provide free, world-class, comprehensive cleft care to their neighbours in need.

So this February, we gathered nurses, nutritionists, paediatricians, social workers — crucial cleft team members who interact with these vulnerable newborns in their first days and weeks of life — from Mexico, El Salvador, Honduras, the Dominican Republic, and Nicaragua to join local colleagues in Antigua, Guatemala for a one-week intensive training on all things cleft nutrition.

The training, which followed a curriculum Smile Train developed in partnership with global nutritional nonprofit SPOON Foundation, covered strategies for helping parents and other caretakers nourish their babies from the moment they are first brought to the breast through to post-cleft -surgery feeding techniques and challenges.

For attendees, it was more than continuing education; it was the key to saving patients’ lives.

Of course, a problem as deep-rooted as malnutrition in children with clefts cannot be solved by 10 women in Guatemala, no matter how well trained. Here, again, the solution is baked into Smile Train’s unique, sustainable model: Facilitators followed up with the trainees a few weeks after they completed the course to assess their local team’s equipment and training needs and examine opportunities for improvement in their internal protocols, with a further progress check scheduled for three months later.

And since all members of the cleft team must know what to do when a patient is at risk of malnutrition, graduates have been busy training their colleagues in all they learnt, empowering them to, in turn, go on to train others.

This extra touch, the signature of Smile Train’s “teach a man to fish model”, turns a single course in Guatemala into something that can change the course of babies’ lives and how cleft care is offered across Central America and the Caribbean now and for generations to come.

“Thank you, Smile Train, for thinking about your partners in El Salvador so that we are able to pass on this knowledge to other doctors and nutritionists”.

– Andrea Abrego, Paediatrician, Smile Train partner Benjamin Bloom Children’s Hospital, El Salvador

“All the information provided in this course will help me provide better tools and a better quality of life to my patients”.

– Nalany Jara, Nutritionist, Smile Train Centro Estatal LPH, Aguascalientes, Mexico

Though this SPOON Foundation-supported curriculum, officially titled “Supporting Comprehensive Cleft Care Through Nutrition and Feeding”, has been successfully used many times since its launch in 2018, this training marked the first time it was taught in Latin America in Spanish — and is yet one more way Smile Train’s donors are changing the world every day, one smile at a time.