The care of a newborn with a cleft lip and palate before surgical repair includes

For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). This will be decided by your child's surgeon. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.

Cleft palate repairs are usually done between the ages of 9 to 18 months, but before the age of 2. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child's physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.

Initial visit

At your first visit with the plastic surgeon, he/she will discuss with you the details of the surgery, risks, complications, costs, recovery time, and outcome. At this time, your child's surgeon will answer any questions you may have.

After the surgery for cleft lip

Your child may be irritable following surgery. Your child's physician may prescribe medications to help with this. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.

Stitches will either dissolve on their own or will be removed in approximately five to seven days. Specific instructions will be given to you regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.

During the surgery, and for a short time after surgery, your child will have an intravenous catheter (IV) to provide fluids until he/she is able to drink by mouth. For a day or two, your child will feel mild pain, which can be relieved with a non-aspirin pain medication. A prescription medication may also be given for use at home.

Your child's upper lip and nose will have stitches where the cleft lip was repaired. It is normal to have swelling, bruising, and blood around these stitches.

After the surgery for cleft palate

This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. Your child's physician may order pain medicine to help with this. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. An intravenous (IV) catheter will be used to help give your child fluids until he/she can drink adequately.

Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days and they do not have to be taken out by the physician. In some cases, packing will be placed on the palate. Do not take the packing out unless you are told to do so by your child's physician.

There may be some bloody drainage coming from the nose and mouth that will lessen over the first day.

There will be some swelling at the surgery site, which will diminish substantially in a week.

For two to three days, your child will feel mild pain that can be relieved by a non-aspirin pain medication. A prescription medication may also be given for use at home.

Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite. Your child's physician may prescribe medication to relieve the nasal congestion.

Your child will be on antibiotics to prevent infection while in the hospital. Your child's physician may want you to continue this at home.

Your child may be in the hospital for one to three days, depending on your child's physician's recommendation.

A small amount of water should be offered after every bottle or meal to cleanse the incision. You can continue to rinse this area gently with water several times a day, if necessary.

Diet after surgery

Your child's physician may allow breastfeeding, bottle-feedings, or cup-feedings after surgery. Your child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes, and gelatin. Note: your child should not use a straw or pacifier, as both could damage the surgical repair.

Activity after surgery

Your child can walk or play calmly after surgery. He/she should not run or engage in rough play (i.e., wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery. Your child's physician will advise you when your child can safely return to regular play.

Follow-up with your child's surgeon and the cleft team is very important. This will be discussed with you. Your child's physician will also be an important part of the child's overall health management after the surgery.

Overview

Cleft lip and cleft palate are fairly common birth defects that can be treated with surgery. They often occur together. Cleft lip happens when the tissues of the upper jaw and nose do not join properly as a baby develops. This causes a split (cleft) in the lip. In most cases a cleft lip does not cause health problems.

Cleft palate happens when the roof of the mouth (palate) does not develop normally during pregnancy. This leaves an opening that may go through to the nasal cavity. It may affect any part of the palate, including the front part of the roof of the mouth (hard palate) or the small tag of tissue that hangs down from the soft palate (uvula). Some babies with cleft palates have trouble feeding.

Both of these conditions are treated with surgery. Cleft lip is repaired in the first few months of a child's life; the timing depends on how bad it is. Cleft palate is usually fixed before 12 months of age, and it often takes more than one surgery.

If your child is born with a cleft lip or palate, it is normal to have concerns and feelings that may include anger, fear, guilt, depression, or denial. You may wonder how your friends, relatives, other children, and even strangers will react to your baby's appearance. Try to focus on bonding with your baby; the other issues will not seem as important over time.

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes.

How can you care for your child at home?

Caring for a child with a cleft lip

• A cleft lip usually does not cause other symptoms or feeding problems. Babies born with cleft lips often can breastfeed well. Bottle-feeding usually is not a problem if you use special nipples that are a different shape and have hole openings that are slightly bigger than normal.
• If a cleft lip occurs with a cleft palate, it is sometimes associated with another health condition. For this reason, it is important for children to be tested for other conditions starting at birth, especially if a baby has other symptoms. Some children with cleft lips may need other tests too, such as tests for speech and hearing problems.

Caring for a child with a cleft palate

• Babies with cleft palates have problems sucking and swallowing, so feeding can be a challenge.
• Watch for signs of dehydration, which can develop if your baby is not getting enough breast milk or formula. These signs include fewer wet diapers, sunken eyes with few tears, and a dry mouth with little or no spit.
• Bottle-feeding usually works better than breastfeeding. Some mothers pump their breast milk and give it to their babies in bottles.
• Watch your baby for problems with choking, gagging, or milk coming out through the nose while feeding. You may wish to use a small plastic plate, called an obturator, that fits into the roof of the baby's mouth while feeding. This blocks the opening so the baby can suck properly.
• As your child grows, pay attention to:
  • Dental care. Children with cleft palates may have special dental problems and need to learn good dental habits early in life.
  • Hearing. Babies with cleft palates need to have their hearing tested by the time they are 3 months old. In some cases, babies born with a cleft palate need ear tubes inserted through surgery. This helps the middle ear work well. It can also restore hearing, reduce pain, and prevent middle ear infections and future hearing problems.
• Sometimes a cleft palate needs treatment before surgery. This may include special dental splints or soft dental moulding inserts.
• You may find it helpful to talk with your doctor or to see a counsellor. Also, you may want to join a support group, which lets you talk with other parents who have babies with a cleft lip or cleft palate.

When should you call for help?

Call 911 anytime you think your child may need emergency care. For example, call if:

• Your child has severe trouble breathing. Signs may include the chest sinking in, using belly muscles to breathe, or nostrils flaring while your child is struggling to breathe.

Call your doctor or nurse advice line now or seek immediate medical care if:

• Your child has signs of needing more fluids. These signs include sunken eyes with few tears, a dry mouth with little or no spit, and little or no urine for 6 hours.
• Your child has signs of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Watch closely for changes in your child's health, and be sure to contact your doctor or nurse advice line if:

• You are worried that your child's surgical scar is not healing right.
• You are worried that your child is not hearing well.
• Your child does not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter H667 in the search box to learn more about "Cleft Lip and Cleft Palate in Children: Care Instructions".

What should nursing care for an infant after the surgical repair of a cleft lip include?

What is the management of cleft lip and cleft palate?

Which of the following is the number one consideration in the care of an infant after the surgical repair of a cleft lip?

What is the immediate concern when a child is born with a cleft lip and or palate?