EXAM 1 Cleft Lip/Palate (Nutrition)

Failure of embryonic facial structures to fuse during development

Cleft lip/palate

Opening/split in the upper lip only

Cleft lip

Opining in the roof of the mouth (hard/soft palate)

Cleft palate

Cleft lip and cleft palate can occur

Alone or together

This birth defect occurs at in which trimester of pregnancy at how many weeks gestation?

1st trimester, 6-8 weeks

Risk factors for Cleft lip/palate

Genetics, family Hx, maternal smoking, alcohol, anticonvulsants, maternal age, poor maternal nutrition

Signs and symptoms of cleft lip is observed

On an ultrasound or at birth

Signs and symptoms of a cleft palate is observed

On an ultrasound or poor feeding, nasal regurgitation, frequent ear infections, poor weight gain

Cleft palate can cause issues with ________ for the child later on in life if left unrepaired

Speech

Complications of having cleft lip (alone) include

Cosmetic concern

________ may still develop normal if palate is intact

Speech

When is cleft lip repaired?

2-3 months

What are the feeding challenges for a baby with cleft lip?

Difficulty latching and poor nipple seal

What are the feeding interventions for a baby with cleft lip?

Sit upright, special nipple/bottle, syringe feed if needed

You should position a baby when not holding them post op cleft lip ________ or _________ to protect the suture line, never prone

Supine, side lying

When is cleft palate repaired?

6-12 months

What are the feeding challenges for a baby with cleft palate?

Nasal regurgitation of milk, aspiration risk, difficulty sucking

What are the feeding interventions for a baby with cleft palate?

Upright feeds, special long nipple/syringe feeder, frequent burping

How should you position a baby post op cleft palate repair? (When not holding them)

Prone or side lying

Why should you position a baby post op cleft palate repair prone or side lying?

Aids in drainage

Complications of cleft palate include

Speech delays, recurring ear infections, hearing loss

Airway considerations for a baby with cleft palate

Aspiration risk, nasal regurgitation

The surgical goal of cleft palate repair is

Restore palate to support speech and feeding

Long term concerns for a child with cleft palate repair

Speech therapy, ENT and dental follow up

If both cleft lip/palate occur together its considered the

Most severe case

When do they repair cleft lip/palate?

Lip first, palate later

What are the feeding challenges for a baby with both cleft lip/palate

Severe feeding difficulty, aspiration, poor weight gain

Complications from having both cleft palate/lip

Highest risk of feeding and nutritional issues, speech and dental problems

Babies with both cleft lip/palate are at risk for both

Aspiration and nutritional risks

Surgical goal for a baby with both cleft lip/palate are

Staged with lip first, palate later

Surgical repair may require __________ surgeries as the child grows

Multiple

Pre-op nursing care for a baby with cleft lip/palate

Small, frequent feeds, never feed supine

Post-op nursing care after surgery is to

Protect suture line, no paci, straw, spoons, elbow restraints

Priority before cleft repair pre-op:

Feeding safely to prevent aspiration

Priority after cleft repair post-op:

Airway first, then protect repair site

What special nipple is used for cleft babies?

Haberman feeder

Long, soft nipple with one way valve that allows milk flow with compression rather than suction (good for cleft palate where suction is weak)

Haberman feeder

Frequent _________ its important with cleft babies to get rid of excess air swallowed

Burping

You should be prepared as the nurse to emotionally support:

The parents