How do you care for a newborn with a cleft lip?
Children with a cleft lip or palate will need several treatments and assessments as they grow up. A cleft is usually treated with surgery. Other treatments, such as speech therapy and dental care, may also be needed. Your child will be cared for by a specialist cleft team at an NHS cleft centre. Children with clefts will have a care plan tailored to meet their
individual needs. A typical care plan timetable for cleft lip and palate is: Your child will also need to attend regular outpatient appointments at a cleft centre so their condition can be monitored closely and any problems can be dealt with. These will usually be recommended until they're around 21 years of age, when they're likely to have stopped growing. Lip
repair surgery is usually done when your baby is around 3 months old. Your baby will be given a general anaesthetic (where they're unconscious) and the cleft lip will be repaired and closed with stitches. The
operation usually takes 1 to 2 hours. Most babies are in hospital for 1 to 2 days. Arrangements may be made for you to stay with them during this time. The stitches will be removed after a few days, or may dissolve on their own. Your child will have a slight scar, but the surgeon will try to line up the scar with the natural lines of the lip, to make it less noticeable. It should fade and become less obvious over time. Palate repair surgeryPalate repair surgery is usually done when your baby is 6 to 12 months old. The gap in the roof of the mouth is closed and the muscles and the lining of the palate are rearranged. The wound is closed with dissolvable stitches. The operation usually takes about 2 hours and is done using a general anaesthetic. Most children are in hospital for 1 to 3 days, and again arrangements may be made for you to stay with them. The scar from palate repair will be inside the mouth. Additional surgeryIn some cases, additional surgery may be needed at a later stage to:
Feeding help and adviceMany babies with a cleft palate have problems breastfeeding because of the gap in the roof of their mouth. They may struggle to form a seal with their mouth – so they may take in a lot of air and milk may come out of their nose. They may also struggle to put on weight during their first few months. A specialist cleft nurse can advise on positioning, alternative feeding methods and weaning if necessary. If breastfeeding is not possible, they may suggest expressing your breast milk into a flexible bottle that is designed for babies with a cleft palate. Very occasionally, it may be necessary for your baby to be fed through a tube placed into their nose until surgery is carried out. Treating hearing problemsChildren with a cleft palate are more likely to develop a condition called glue ear, where fluid builds up in the ear. This is because the muscles in the palate are connected to the middle ear. If the muscles are not working properly because of the cleft, sticky secretions may build up within the middle ear and may reduce hearing. Your child will have regular hearing tests to check for any issues. Hearing problems may improve after cleft palate repair and, if necessary, can be treated by inserting tiny plastic tubes called grommets into the eardrums. These allow the fluid to drain from the ear. Sometimes, hearing aids may be recommended. Read more about treating glue ear. Dental careIf a cleft involves the gum area, it's common for teeth on either side of the cleft to be tilted or out of position. Often a tooth may be missing, or there may be an extra tooth. A paediatric dentist will monitor the health of your child's teeth and recommend treatment when necessary. It's also important that you register your child with a family dentist. Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. This can include braces or other dental appliances to help straighten the teeth. Brace treatment usually starts after all the baby teeth have been lost, but may be necessary before a bone graft to repair the cleft in the gum. Children with a cleft are more vulnerable to tooth decay, so it's important to encourage them to practise good oral hygiene and to visit their dentist regularly. Speech and language therapyRepairing a cleft palate will significantly reduce the chance of speech problems, but in some cases, children with a repaired cleft palate still need speech therapy. A speech and language therapist (SLT) will assess of your child's speech several times as they get older. If there are any problems, they may recommend further assessment of how the palate is working and/or work with you to help your child develop clear speech. They may refer you to community SLT services near your home. The SLT will continue to monitor your child's speech until they are fully grown and they will work with your child for as long as they need assistance. Further corrective surgery may sometimes be required for a small number of children who have increased airflow through their nose when they're speaking, resulting in nasal-sounding speech. Specialist UK cleft lip and palate centresEngland
Wales
Scotland
Northern Ireland
Page last reviewed: 13 August 2019 What are feeding considerations in the newborn with cleft lip and cleft palate?Though babies with a cleft palate can't breastfeed, moms can feed them breast milk in the bottle. They also can do non-nutritive sucking to further bond with their babies. This is when a baby sucks at the breast for comfort, not for feeding. Limit your baby's non-nutritive sucking to less than 10 minutes per feed.
What happens when a baby is born with cleft lip?Children with a cleft lip with or without a cleft palate or a cleft palate alone often have problems with feeding and speaking clearly and can have ear infections. They also might have hearing problems and problems with their teeth.
Which does the care of a newborn with a cleft lip and palate before surgical repair include?Your child may have breast milk up to 4 hours and formula up to 6 hours before surgery. All other liquids, semi-liquids and solid foods MUST BE STOPPED 8 hours before surgery. Your child may have CLEAR LIQUIDS up to 2 hours before surgery. After that, they may have nothing else to drink.
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