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.

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Bottlefeeding

A. Advantages
1. Provides an alternative to breastfeeding
2. Less restrictive than breastfeeding; may meet needs of working mothers
3. Allows a more accurate assessment of intake
4. May be indicated in the presence of a congenital anomaly such as cleft palate
5. May be necessary for infants who require special formulas because of allergies or inborn errors of metabolism

B. Types of formulas
1. Commercial liquid or powdered formulas
2. Special formulas
3. Unmodified regular cow’s milk, liquid or reconstituted; not appropriate for infants before 12 months of age; cow’s milk contains more protein, more calcium, less vitamin C, less iron, and less carbohydrate

C. Contraindications
1. Inadequate intelligence to prepare formula
2. Poor storage and refrigeration practices
3. Contaminated water supply
4. Cost of formula and equipment
5. Lack of equipment to adequately prepare bottles

Nursing Care of the Mother Who Is Bottlefeeding

A. Assessment
1. Desire to bottlefeed
2. Sucking ability of infant
3. Knowledge of formulas and formula preparation (more…)

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Breastfeeding Mnemonics:

Breast feeding: benefits ABCDEFGH:
• Infant:
Allergic condition reduced
Best food for infant
Close relationship with mother
Development of IQ, jaws, mouth
• Mother:
Econmical
Fitness: quick return to pre-pregnancy body shape
Guards against cancer: breast, ovary, uterus
Hemorrhage (postpartum) reduced

A. Advantages
a. Psychologic value of closeness and satisfaction in beginning of mother-child relationship
b. Optimum nutritional value for infant
c. Economic and readily accessible (more…)

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Wanted to buy new IMCI book? Still asking for your financial providers? Now, thanks for visiting here, YOU can now download the IMCI Manual for free. Keep sharing and enjoy reading

(Download link after the jump) (more…)

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1. Denial, Anger, Bargaining, Depression, and Acceptance (DABDA) are grief reactions according to Kubler-Ross.
2. Hearing ability is the last to disappear in a dying person.
3. Flat EEG is the most accepted criterion or definition of death
4. Between 9-10 years old develops the universal concept of death,  that it is a permanent biology.

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Dear Readers,

I’m planning to cultivate deeper on Cystic Fibrosis. There will be a series of discussions to help out in understanding the world of Cystic Fibrosis.

CF At A Glance:

• Cystic Fibrosis (CF) is one of the most common serious genetic (inherited) diseases.
• CF gene is carried by 1/29 persons (in Caucasian populations) and 1 in 400 couples is at risk for having children with CF
• CF is characterized by the production of abnormal secretions leading to mucous build-up.
• CF mucous build-up in lungs can impair respiration
• Early diagnosis of CF is of greater importance
• Early and continuing treatment of CF is valuable.

What is Cystic Fibrosis?

Cystic Fibrosis (CF) is caused by a defect in a gene called the cystic fibrosis transmembrane conductance regulator (CFTR). This gene makes a protein that controls the movement of salt and water in and out of the cells in your body. In people with CF, the gene does not work effectively. This causes the thick, sticky mucus and very salty sweat that are the main features of CF.

CF is caused by defects in the gene for cystic fibrosis transmembrane conductance regulator (CFTR), which encodes for a protein that functions as a chloride channel and is regulated by cyclic adenosine monophosphate (cAMP). Mutations in the gene for CFTR (CFTR) result in abnormalities of cAMP-regulated chloride transport across epithelial cells on mucosal surfaces. Defective CFTR results in decreased secretion of chloride and increased reabsorption of sodium and water across epithelial cells. Resultant reduced height of epithelial lining fluid and decreased hydration of mucus results in mucus that is stickier to bacteria, which results in infection and inflammation. These abnormalities result in viscid secretions in the respiratory tract, pancreas, gastrointestinal tract, sweat glands, and other exocrine tissues. Increased viscosity of these secretions makes them difficult to clear. (more…)

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Caput succedaneum:

is caused by the mechanical trauma of the initial portion of scalp pushing through a narrowed cervix. Edema of the soft tissue over bone (crosses over suture line); subsides within few days

A caput succedaneum is more likely to form during a prolonged or difficult delivery. This is especially true after the membranes have ruptured, thus removing the protective cushion of the amniotic sac. Vacuum extraction can also increase the chances of a caput succedaneum.

However, a caput succedaneum is sometimes identified by prenatal ultrasound even before labor or delivery begins. It has been found as early as 31 weeks of gestation. More often than not, this is associated with either premature rupture of the membranes or too little amniotic fluid (oligohydramnios). All other things being equal, the longer the membranes are intact, the less likely a caput is to form. (more…)

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