Cleft Palate

WHAT YOU SHOULD KNOW

Causes

Risks

WHAT YOU SHOULD DO

• You may need to feed the baby with a soft bottle. Gently squeeze the bottle so milk comes slowly out of the nipple.
• There are many kinds of bottle nipples. Your doctor will work with you to find the best one for your baby.
• A rubber-tipped syringe may aid in feeding. The tip of this device is long enough to reach into the back of the baby's mouth, so that the liquid will not go up through the cleft and into the nose.
• Hold your baby in a sitting position during feedings. This helps to keep liquid from going into the nose, where it can be inhaled or spread into the ears.
• Feed your baby slowly. A baby with a cleft palate can swallow a lot of air when feeding, so burp the baby frequently---after each 1 to 2 ounces of liquids.
• Don't keep taking the nipple in and out of the baby's mouth during feedings. This can upset the baby---and crying during feedings can cause the baby to inhale the formula.
• If saliva and milk get into the baby's ears, they could cause an infection. Changing your baby's position often will help to prevent this.

IF YOU'RE HEADING FOR THE HOSPITAL...

Before You Go

• The Weeks Before Surgery:
• The child will need to wear padded elbow boards for a while after the operation. You can prepare the youngster by showing how they work. Put them on the child's arms and let him or her play with them for a short time. After the surgery, they'll seem less frightening.
• Teach the child in advance to drink from a cup, the side of a spoon, or a rubber-tipped syringe. Then, in the stressful time after the operation, it won't be necessary to learn.
• Practice cleaning the child's mouth with a spray bottle. Have the youngster sit up with head thrust forward, then gently spray water or salt water on the roof of the mouth. Let the child hold the spray bottle to become familiar with it.
• You'll probably need to take the child in for blood tests prior to the operation.
• Check with your doctor before giving the child any over-the-counter drugs in the days before the operation.
• The Night Before Surgery:
• The child may be given medicine to help bring on sleep.
• The child should not eat or drink anything---including water---for several hours before the operation. Your doctor will tell you when to stop feeding.
• Call Your Doctor If...
• Your child gets a cold or flu or runs a high temperature. The surgery may need to be postponed.

When You Arrive

• Check with your doctor before giving the child insulin, diabetes pills, or any other medicine.

What to Expect While You're There

• Taking Vital Signs: These include your baby's temperature, blood pressure, pulse (counting the heartbeats), and respirations (counting the breaths). A stethoscope is used to listen to the baby's heart and lungs. Blood pressure is taken with a cuff around the arm.
• Blood Tests: Blood samples are usually needed for tests. The blood can be taken from a vein in the hand or the bend in the elbow.
• Emotional Support: The child will feel safer in the hospital when you're nearby. You'll be encouraged to stay as long as you can.
• Chest X-ray: The doctor will check this picture of the lungs and heart to make sure there are no problems before surgery. X-rays can also reveal signs of infection such as pneumonia.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG.) To check the baby's heart, nurses will position 3 to 5 sticky pads on different parts of the body. The pads are connected to a TV-like screen or a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your child's vein for giving medicine and liquids. The IV will be capped or connected to tubing and liquid.
• Pulse Oximeter (oks-IH-mih-ter): A clip placed on the baby's ear, finger, or toe will be connected to a machine that measures the oxygen level in the blood.
• General Anesthesia: This will keep the child completely asleep and pain-free during the operation. It may be given as a liquid in the IV, as a gas through a face mask, or through an endotracheal (end-o-TRAY-kee-ull) tube or "ET tube" inserted through the child's mouth.

During Surgery

After Surgery

• Activity:
• Your child should not get out of bed until the doctor says it's OK. If the youngster is in a crib keep the side rails up at all times for safety.
• The child's mouth will need protection after surgery. Padded boards will keep the elbows straight and prevent the child from putting things into his mouth. Take the restraints off 3 or 4 times a day to exercise the child's arms, 1 arm at a time. Do not leave the youngster alone when the restraints are off.
• Sucking, blowing bubbles, laughing, and crying can put stress on the roof of the mouth. Holding, cuddling, and talking will help to keep the child calm and happy. To minimize crying, also be sure to keep the child fed, dry, and rested.
• It's OK for the child to sleep on his stomach.
• Eating:
• Your child can start drinking liquids right after surgery. Use a cup, the side of a spoon, or a rubber-tipped syringe. Do not use a bottle or straw.
• The doctor will tell you when to start feeding your child soft foods that need not be chewed. Applesauce, custard, pudding, or other mashed foods are all good choices. Limit the diet to soft foods for about 1 month. Don't give the child lollipops, or let him feed himself. This could damage the surgery.
• Intake and Output: The doctor may need to know how much liquid your child is getting and how much he or she is urinating. This is often called "I&O."
• When the doctor says it's OK, encourage the child to drink as much water as the doctor allows. If the child is on I&O, keep a record of the amount the child drinks.
• Ask your doctor if it's OK to flush the child's urine down the toilet, and whether you should save the diapers.
• Medicines:
• Antibiotics: These medicines may be prescribed to help fight bacterial infection. They may be given by IV, as a shot, or by mouth.
• Pain Medicine: This may be given in the child's IV, as a shot, or by mouth. Tell your doctor or nurses if the youngster's pain won't go away or keeps coming back.
• Anti-Nausea Medicine: If the pain medicine proves upsetting, the doctor can prescribe additional drugs to settle the stomach and control vomiting.
• Oxygen: If extra oxygen is needed, the youngster may be placed in a clear plastic mist tent or a high humidity room to help ease breathing. Don't shut off the oxygen supply without asking a doctor. This could leave the child dangerously oxygen-deprived.

After You Leave

• Always give your child medicine exactly as directed. If it doesn't seem to be helping, tell the doctor, but don't quit giving it on your own. If the doctor has prescribed antibiotics, be sure to use them up even if the child seems to feel better.
• If the child's mouth is kept moist, it will be more comfortable. Rinse it after each feeding and at bedtime by gently spraying water or salt water on the site of the surgery with a spray bottle. To prevent choking, have the child sit up with head thrust forward.
• To reduce the risk of infection, keep the child away from people with colds, flu, or other diseases until the surgery has healed.

Call Your Doctor If...

• The child develops itchy, swollen skin or a rash. This could be a sign of allergy to a medicine.
• The child is running a high temperature.
• The child's pain gets worse or won't go away.
• You see pus coming from the stitches, or the area around them is red and swollen. These are signs of infection.
• The stitches come apart.
• You have problems feeding the baby.

Seek Care Immediately If...

• The child suddenly can't breathe; or has blue lips, fingernails, or toenails. The airway may be blocked, or the child could be having an allergic reaction. Either way, this is an emergency. Call (0) operator or 911 to get help right away.