Which does the care of a newborn with a cleft lip and palate before surgical repair include?

Summary

• A cleft palate or cleft lip (or both) is a birth condition in which parts of the mouth do not join up during early fetal development. 
• The cause is unknown, although genetic factors sometimes play a role.
• Cleft conditions vary in severity and extent.
• A cleft lip or palate can be repaired through surgery.
• Surgery can assist with the development of a child’s face and speech.
• A baby with a cleft lip can usually breastfeed or bottle-feed well.
• A baby with a cleft palate needs a specialised approach to support feeding.

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This page has been produced in consultation with and approved by:

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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".

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