Cleft Lip and Palate

Risk Factors

• Genetic syndromes

• family history

• maternal and environmental factors; exposure to alcohol, cigarette smoke, anticonvulsants, retinoids, or steroids during pregnancy

• Folate deficiency during pregnancy

Patient-Centered Care

1. support and encourage parents

2. promote bonding

3. promote healthy self-esteem throughout the child’s development

Therapeutic Procedures: Cleft Lip

• Repair typically done between 2 to 3 months of age

• Additional surgeries are usually required to the lip and nose in severe defects

Therapeutic procedures: Cleft Palate

• Repair typically done between 6 to 12 months of age

• Most require additional surgeries to improve speech quality and aesthetic outcome

Pre-op nursing actions

• Inspect the lip and palate; at birth

• assess ability to suck

• obtain baseline weight: make sure getting nutrients

• Determine emotional needs of parents

• Instruct parents about proper feeding and care

• assess ability to feed: watch parents

• initiate strategies for successful feedings

Infant Care

Breastfeeding: upright position and side lying for aspiration risk

Educate parents proper nipple for bottle

Feed infant slowly, burp more often, cleanse mouth with water after feedings

Pre-Op for Cleft Lip

1. Encourage breast feeding

2. Use a wide-based nipple for bottle feeding

3. Squeeze the infant’s cheeks together during feeding

Pre-Op for Cleft Palate or Cleft Lip and Palate

Position: Position the infant upright while cradling the head during feeding

Use: Use a specialized bottle with a one-way valve and a specially cut nipple

Burp: Burp the infant frequently

Postoperative nursing actions

Keep the infant pain-free to; administer analgesics as prescribed

Assess operative sites; for infection

Avoid having the infant suck on a nipple or pacifier

Avoid spoons, forks, and other objects that could damage the incision site

Monitor I & O and weigh daily

Observe the family’s interaction with the infant

Determine emotional needs of the family and provide support

-Keep babies restrain arms to not reach or grab mouth

-Social Services if not bonding

Post- Op care for Cleft Lip

• Monitor the integrity of the post-op protective device: restrains

• Position the infant on the back or on the side during the immediate postoperative period to maintain the integrity of the repair

• Apply elbow restraints to keep the infant from injuring the repair site

• Use sterile 0.9% sodium chloride, sterile water diluted hydrogen peroxide to clean the incision site -Apply antibiotic ointment if prescribed

• Gently aspirate secretions of mouth and nasopharynx to prevent respiratory complications

Post Op care for Cleft Palate

• Change the infants position frequently

• place the infant in side-lying position

• maintain IV fluids until the infant is able to eat and drink

• the infant is usually NPO for 4 hr then allowed liquids only for the first 3 to 4 days, then progressed to a soft diet

• avoid placing a straw, tongue depressor, hard pacifier, rigid utensils, hard-tipped sippy cups, or suction catheters in the infant’s mouth

• elbow restraints

• close observation for manifestations of airway obstruction, hemorrhage, and laryngeal spasm; can cause difficult to breathe

• use a face mask to deliver oxygen

Complications

Ear infections and hearing loss- Audiologist

Speech and language impairment: Speech pathology