CLEFT LIP AND CLEFT PALATE

Incomplete closure of the lip and palate or root of the mouth.

Etiology: The exact cause of the lip and palatal clefting is not known, but most experts feel that it is due to both genetic and environmental factors.

Related Causes: Genetic; Folic acid deficiency; steroid, exposure to TORCH.

Common problems:

  • feeding difficulty

  • infections - upper respiratory and ear

  • speech defect (cleft palate)

  • dental defect (nasal twang)

  • altered normal body image

  • respiratory distress

Treatment: Surgery

  1. Cleft Lip: CHEILOPLASTY

  2. Cleft palate: PALATOPLASTY - done before speech development.

Preoperative care:

  • proper positioning especially during and after feeding - upright positioned

  • burp or bubble the newborn more often

  • feed the baby with the use cross cut large holed nipple or Breck feeder technique

  • observe for signs of complication: Otitis Media

  • For dental defects: Orthodontic exercise and surgery

  • speech therapy

Postoperative care:

  • Proper positioning: CL- supine or side lying; CP: prone

  • Apply elbow restraint and release every 2 hours

  • Give feeding with rubber tipped medicine dropper for cleft lip and paper cups and soup spoons for cleft palate

  • Cleanse the wound with hydrogen peroxide

  • Give post operative medications which include analgesic and antibiotic

  • Avoid sucking, suctioning, blowing, pointed and sharp objects (spoon, fork, and straw)

  • Make sure baby does not suck the LOGAN’S BAR OR BOW

Feeding an Infant with a Cleft:

Feeding an infant is important not only in providing nourishment, it also provides an intimacy and closeness for both the parent and the child. Infants with a cleft lip seldom have problems either by bottle or breast.

In babies with clefts of the hard palate, the opening in the roof of the mouth often causes difficulty in creating adequate pressure on the nipple, thus creating an inability to suck well enough to get adequate nourishment. Feeding the infant takes patience and practice.

During my school days, we recommended the use of soft squeezable plastic bottle like Mead Johnson with an orthodontic nipple such as Nuk. You can increase the flow by gently squeezing or putting pressure on the bottle. It is important to feed the infant before he/she becomes too hungry. Position the infant in an upright position with the head tilted back slightly. This position allows the milk to flow down into the throat and less into the nose. Infants with clefts do swallow more air and need to be burped frequently. At first, it may take extra time, but this will steadily decrease. Feeding time of the newborn varies from 20-30 minutes. When feeding takes longer than 45 minutes, the infant may be burning up calories necessary to gain weight.

Breast feeding the newborn with a cleft palate is often unsuccessful. Generally the infant cannot produce enough negative pressure to obtain ample breast milk to provide adequate nourishment. Using a breast pump to extract the milk and feeding the infant breast milk from squeezable bottle is recommended.