Chapter 24: Cleft Lip and Palate (Children)

Question 1

Cleft lip (CL), Cleft palate (CP)

Answer 1

multi-factorial congenital defect that has genetic and environmental predispositions
-Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both.

Question 2

What happens during intrauterine fetal life for this to occur?

Answer 2

-the primary palate does not fully fuse, and and one of the several variations of clefts can occur depending on the timing of the insult

Question 3

Signs and Symptoms

Answer 3

• unilaterally or bilaterally cleft lip
• can occur with or without a cleft of the hard and/or soft palate
• both or either of the palates can have a cleft without the lip
• uvula can also contain a cleft

Question 4

Diagnosis

Answer 4

-CL is obvious, but CP calls for examination of the mouth with a light source

Question 5

Nursing Care

Answer 5

• maintain adequate nutrition
• can be successfully breastfed; breastfeeding can be interrupted for a period of time based on the need for surgical repair
• bottle feeding is initiated with a special nipple that is longer than a regular nipple to help prevent aspiration
• Haberman feeder (longer and has a reservoir to regulate the flow of formula
• newborns with clefts are fed in an upright position to decrease the incidence of regurgitation and aspiration
• no sucking until lip is healed, use syringe or dropper

Question 6

Haberman Feeder

Answer 6

• longer

- has a reservoir to regulate flow of formula

Question 7

What position do we feed a newborn with clefts?

Answer 7

upright position to decrease the incidence of regurgitation an aspiration

Question 8

Surgical repair

Answer 8

surgical repair of Cleft lip is done at 3 months of age

• Cleft palate repaired before 18 months
• some clefts require more than one surgical repair

Question 9

Education/ Discharge

Answer 9

• parents supported by having all the treatments, feeding methods, and care measures explained
• emotional support needed to assist in grieving process of dealing with the reality of a “non-perfect” child with possible on-going surgical needs and feeding problems
• later in life may experience psychosocial problems b/c of facial deformity