Cleft Lip and Palate and Hip Dysplasia

Cleft lip and/or cleft palate

Facial malformations that occur during embryonic development

Cleft lip

Failure of the maxillary and median nasal processes to fuse. Can be bilateral or unilateral

Cleft palate

A midline fissure of the palate that results from failure of the two sides to fuse. Can be isolated or associated with cleft lip

18 week ultrasound.

When is cleft lip normally picked up?

At risk for impaired bonding and even rejecton

If parents didnt know about baby being born with cleft lip, what are they at risk for?

1. send photos

2. send blanket with the scent

Ways nurses can facilitate bonding when baby has cleft lip/palate [2]

Pierre-Robin syndrome

Syndrome associated with cleft lip and palate where chin is tiny

Valproic acid

Anti-epileptic med that poses high risk for cleft lip and palate:

If sibling has it. Otherwise no strong genetic link

When is baby more likely to get cleft lip/palate?

Between 7-11 weeks

Merging of the upper lip at the midline is completed between ___-____ weeks gestation

7-12 weeks

Fusing of the seconary palate takes place between _____-____ weeks gestation

put gloved finger in baby’s mouth, they will suck on it. Turn the finger around to feel the whole palate (sometimes it is only a tiny hole)

How to feel for cleft palate:

Milk can actually move back.

Why do babies with cl/p get frequent ear infections?

May have trouble getting a seal. Easier with breastfeeding because can fill with breast tissue.

Feeding problems with cleft lip:

The palate helps with suction to bring milk in (negative pressure). they may have trouble actually drawing out milk

Feeding problems with cleft palate:

They aren’t getting good suction, can start choking and gagging

Why might babies with cl/p have milk come out of nose/mouth?

Not getting enough milk

Why might babies with cl/p have growth retardation?

Teeth and gumline may not be aligned.

Why will babies with cl/p have poor speech?

1. sit baby op to feed, let gravity help

2. Use their band to manipulate cheeks closed around bottle

3. Special bottles with different valves and flow

How will occupational therapist help baby with cl/p feed before sugery? [3]

1. CBC (WBC, hemoglobin, platelets) sometimes with differential

2. electrolytes

3. blood type and cross

4. PT time (sometimes)

Preop bloodwork ordered before cl/p surgery? [4]

Protect that scar.

Nurse’s priority after CL/P surgery:

Elbow restraints

How to prevent baby scratching at suture lines after cleft lip surgery?

Every four hours, never let parents take them off

How often to take elbow restraints off?

May rub their faces on the mattress. Need to be constantly watching them or pick them up.

Why don’t we want babies on their bellies after cleft lip surgery?

7 days at least

How long will suture lines for cleft lip take to heal?

gently with sterile water if feeding or it gets messy

How to clean suture lines after cleft lip surgery:

Only soft, pureed, blended foods. Anything hard can break open the incision.

What do babies eat post cleft palate surgery.

1. not out of a straw (suction and can poke suture lines)

2. Breast feed them

3. give them cups

4. don’t give

How can babies drink after cleft palate surgery?

Anyting with red dye in it. Unable to tell if vomit is blood.

Specific thing babies cannot eat or drink after cleft palate surgery:

1. Trying to clear their throat

2. gagging

3. Drooling

4. swallowing lots

How to tell if baby after cleft palate surgery is bleeding:

NO! Causes suction and can also poke suture lines.

Can babies have a pacifier after cleft palate surgery?

Sometimes the colour tells the flow

How to tell the difference in different bottles:

Cleft lip

If baby has both cleft lip and palate, which is corrected first?

at ten weeks, or 4.5kg. Usually before three months

When does cleft lip surgery happen?

1. clean with gauze and sterile water to prevent infection

2. Petroleum jelly on the line

3. scar massage to avoid scarring

Depending on the surgeon, what might they order after surgery to help with healing of the incision? [3]

Between 6-12 months old but before 18 months

When does cleft palate surgery happen?

Want to correct it before they start to talk

Why does cleft palate surgery need to happen before 18 months?

Opioid pain medication for first 24-48 hours, then switch to tyelenol. All around the clock

What pain medications doo babies receive after cl/p surgery?

1. tachypnic?

2. Turning pale?

Signs of respiratory destress to look out for post-op

It dries out the suture line

Why does mouth breathing pose greater risk for infection?

1. Wearing a good spf on scar

2. sometimes facial hair won’t grow on suture line

Teaching about the suture scar to teach parents about post-op:

Developmental Dysplasia of the Hip

 Broad term that describes a spectrum of disorders related to abnormal development of the hip. The femoral head and acetabulum are improperly aligned

acetabular dysplasia

the femoral head fails to exert enough pressure against the acetabulum

Sublaxated

he femoral head is in contact with the acetabulum, but not centered deeply within

Dislocation

the femoral head is no longer in contact with the acetabulum

Galeazzi sign

Shortening of the limb on the affected side

Ortolani test

Lie baby on back, flex hip and knees at 90 degrees. place hands by greater trochanter and gently abduct their legs. Positive if there is a clicking noise.

Barlow test

Lie them down, adduct the hips. Palpate by greater trochanter. You can feel the femoral head slipping out and come out and dislocate.

Trendelenberg sign

For older kids, hold onto a chair, stand on one foot, and switch. Hips should stay straight. Check alignment of the pelvis at the weight-bearing foot

Asymmetry of gluteal and thigh fold

Sign of hip dysplasia. There are more wrinkles on one leg than the other when placed on back

1. lordosis

2. sciatic nerve injury

3. Avascular necrosis of femoral head

4. soft tissue damage

5. permanent disability

complications if hip dysplasia is not corrected: [5]

newborn - 6 months

Age for pavlik harness:

6-18 months

age for spica cast:

older than 2

age for skin or skeletal traction:

knee socks and onesie underneath

what goes under pavlik harness?

Most of the day, only really take off to take a bath

How long is pavlik harness kept on?

Spica cast

Immobilization device of the hips, goes up to belly and down past knees.

1. petal the cast (waterproof tape around the edges)

2. Take a smaller diaper than the baby is currectly in, tuck it in the hole, then bigger diaper over the whole thing.H

How to keep spica cast clean

12 weeks or longer

How long will spica cast stay on?