Materiały źródłowe

• #1 Cleft Lip/Cleft Palate | Birth Defects | CDC

  https://www.cdc.gov/birth-defects/about/cleft-lip-cleft-palate.html

  Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth don’t form properly. […] Service and treatment needs can vary depending on the size of a cleft. […] If the orofacial clefts are not surgically repaired, children with these conditions have problems with feeding and speaking clearly. They may also more often have ear infections and hearing problems, or problems with their teeth. […] Services and treatment for children with orofacial clefts can vary depending on: The severity of the cleft, The child’s age and needs, The presence of associated syndromes or other birth defects. […] Surgery to repair a cleft lip usually occurs in the first few months of life. It is recommended within the first 12 months of life. Surgery to repair a cleft palate is recommended within the first 18 months of life, or earlier if possible.

• #2 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Cleft Lip Palate Nursing Care Plans and Nursing Diagnosis […] A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. […] In infants diagnosed with cleft lip, the fusion fails to occur in varying degrees, causing this disorder to range from a small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline. […] A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

• #3 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Cleft Lip Palate Nursing Care Plans and Nursing Diagnosis […] A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. […] In infants diagnosed with cleft lip, the fusion fails to occur in varying degrees, causing this disorder to range from a small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline. […] A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

• #4

  https://www.healthychildren.org/English/health-issues/conditions/Cleft-Craniofacial/Pages/Cleft-Lip-and-Palate-Parent-FAQs.aspx

  One in every 700 babies is born with a cleft lip, a cleft palate, or both making it one of the most common birth defects. […] Babies born with a cleft lip and/or palate need special care from a team of different health professionals. Their care must be well managed because of the difficult medical, surgical, dental and social factors important to treatment decisions. […] The type of cleft lip and/or palate a child has will determine the kind of care that he or she needs. […] In general, babies with a cleft palate either as cleft lip with cleft palate or cleft palate alone, suck weakly and need a special bottle to feed. Support from a feeding therapist, certified lactation consultant, and/or nurse experienced in feeding children with cleft palate is recommended for parents. […] Various specialists will care for your child at different times and stages. The cleft/craniofacial team usually includes nurses, social workers, nutritionists, audiologists, speech-language pathologists, geneticists, pediatricians, dentists, orthodontists and pediatric surgeons (otolaryngologists, oral and maxillofacial surgeons, and plastic surgeons).

• #5 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Treatment may take many years and require several surgeries. But most children affected by these conditions have a normal childhood. Treatment helps improve speech and feeding issues. […] Its possible to breastfeed your baby if they have cleft lip and/or cleft palate. But youll need support from trained healthcare providers. […] Generally, children with clefts have the same dental needs as other children. However, children with cleft lip and palate may also have missing, misshapen or poorly positioned teeth. […] Problems with eating, hearing and speech are common in children with clefts. Children may also have issues with their teeth or self-esteem.

• #6 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Cleft Lip Palate Nursing Care Plans and Nursing Diagnosis […] A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. […] In infants diagnosed with cleft lip, the fusion fails to occur in varying degrees, causing this disorder to range from a small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline. […] A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

• #7 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Cleft Lip Palate Nursing Care Plans and Nursing Diagnosis […] A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. […] In infants diagnosed with cleft lip, the fusion fails to occur in varying degrees, causing this disorder to range from a small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline. […] A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

• #8 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Cleft Lip Palate Nursing Care Plans and Nursing Diagnosis […] A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. […] In infants diagnosed with cleft lip, the fusion fails to occur in varying degrees, causing this disorder to range from a small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline. […] A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

• #9 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Cleft Lip Palate Nursing Care Plans and Nursing Diagnosis […] A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. […] In infants diagnosed with cleft lip, the fusion fails to occur in varying degrees, causing this disorder to range from a small notch in the upper lip to total separation of the lip and facial structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline. […] A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

• #10 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Treatment consists of surgical repair, usually of the lip between 6 to 10 weeks of age, followed by the palate between 12 to 18 months of age. The surgical procedures depend on the child’s condition and physician preference. Management involves a multidisciplinary approach that includes the surgeon, pediatrician, nurse, orthodontist, prosthodontist, otolaryngologist, and speech therapist. […] Nursing goals for clients diagnosed with cleft lip and palate include maintaining adequate nutrition, increasing family coping, reducing the parents’ anxiety and guilt regarding the newborn’s physical defects, and preparing parents for the future repair of the cleft lip and palate. […] The following are the nursing priorities for patients with cleft lip and cleft palate: […] Feeding Difficulties. Infants with cleft lip and cleft palate may have difficulties in breastfeeding or bottle feeding due to structural abnormalities. Ensuring adequate nutrition and addressing feeding challenges are crucial for their growth and development.

• #11 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Nursing Goals […] Goals and expected outcomes may include: […] The infant will maintain a clear airway as evidenced by clear breath sounds and the absence of cyanosis. […] The infant will display a respiratory rate of 20 to 30 breaths per minute, absence of retractions, and respiratory distress. […] The neonate will exhibit adequate nutritional status to maintain growth and healing. […] The family will report decreased anxiety levels concerning the infant’s condition. […] The family will demonstrate problem-solving skills and the use of resources effectively. […] The family will increase coping ability concerning the infant’s condition and care needs. […] The parents will verbalize that they believe there will be a positive outcome for the infant. […] The parents will demonstrate coping behaviors evidenced by holding and helping with infant care.

• #12 Cleft Lip/Cleft Palate: Feeding Your Child (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/clefts-feeding.html

  When a baby is born with a cleft, it’s important to help the baby feed well to prevent dehydration and make sure they gain weight. Babies born with a cleft may need some special feeding help. […] Babies born with a cleft palate, whether with a cleft lip or without, can’t breastfeed. That’s because they can’t create the pressure needed to suck milk from the nipple. Trying to breastfeed or use a regular bottle system to feed a baby with a cleft palate can lead to poor weight gain and failure to thrive. […] Babies with a cleft palate need to be fed with a specialty bottle system. It provides the proper nutrition without the need for pressure while sucking. […] Feeding challenges put babies with a cleft palate at risk for failure to thrive. Regular weight checks by your baby’s doctor or the cleft team can help make sure your baby is gaining enough weight. […] Feeding a baby with cleft lip/palate can be a challenge at first. But help is available. Look to the cleft team for support and information.

• #13 Cleft Lip/Cleft Palate: Feeding Your Child (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/clefts-feeding.html

  When a baby is born with a cleft, it’s important to help the baby feed well to prevent dehydration and make sure they gain weight. Babies born with a cleft may need some special feeding help. […] Babies born with a cleft palate, whether with a cleft lip or without, can’t breastfeed. That’s because they can’t create the pressure needed to suck milk from the nipple. Trying to breastfeed or use a regular bottle system to feed a baby with a cleft palate can lead to poor weight gain and failure to thrive. […] Babies with a cleft palate need to be fed with a specialty bottle system. It provides the proper nutrition without the need for pressure while sucking. […] Feeding challenges put babies with a cleft palate at risk for failure to thrive. Regular weight checks by your baby’s doctor or the cleft team can help make sure your baby is gaining enough weight. […] Feeding a baby with cleft lip/palate can be a challenge at first. But help is available. Look to the cleft team for support and information.

• #14 Cleft Lip/Cleft Palate: Feeding Your Child (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/clefts-feeding.html

  When a baby is born with a cleft, it’s important to help the baby feed well to prevent dehydration and make sure they gain weight. Babies born with a cleft may need some special feeding help. […] Babies born with a cleft palate, whether with a cleft lip or without, can’t breastfeed. That’s because they can’t create the pressure needed to suck milk from the nipple. Trying to breastfeed or use a regular bottle system to feed a baby with a cleft palate can lead to poor weight gain and failure to thrive. […] Babies with a cleft palate need to be fed with a specialty bottle system. It provides the proper nutrition without the need for pressure while sucking. […] Feeding challenges put babies with a cleft palate at risk for failure to thrive. Regular weight checks by your baby’s doctor or the cleft team can help make sure your baby is gaining enough weight. […] Feeding a baby with cleft lip/palate can be a challenge at first. But help is available. Look to the cleft team for support and information.

• #15 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Position the infant appropriately after surgery. Following a cleft lip repair, be sure the infant does not turn onto their abdomen because this could put pressure on the suture line, possibly tearing it. Careful positioning ensures the prevention of injury to the operative site. […] Provide special nipples or feeding devices such as pigeon feeders with a one-way valve. Feeding may work better using special bottles or nipples with a wider base. A syringe with a rubber tip, a long nipple with a large hole attached to a squeeze bottle, or a medicine dropper can be used to feed the infant formula or breast milk before and after surgery because sucking motions must be avoided to keep from applying tension on the suture line. […] Coordinate with other healthcare teams for the holistic care and management of the infant. Treatment of the infant diagnosed with cleft lip and palate requires multidisciplinary teamwork with a surgeon, pediatrician, pediatric dentist, orthodontist, nurse, psychologist, speech therapist, and social worker. The public health nurse should be responsible for coordinating parental counseling and referral as needed.

• #16 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Position the infant in an upright position greater than 60 during feeding and elevate the head of the crib to 30 after. General recommendations for body mechanics in infants with cleft lip or palate while feeding include the following: head support for neutral alignment of head and neck; arms forward, trunk midline, hips flexed; and lip, cheek, and jaw stabilization to provide a platform for sucking movements. Infants with cleft palate are fed in an upright position greater than 60 to allow gravity to facilitate fluid transfer and decrease the tendency for nasopharyngeal reflux. […] Allow the infant time to swallow during feedings and provide oral care as appropriate. Placing a small amount of breast milk or formula into the infant’s mouth and allowing time for swallowing will prevent aspiration. Offering small amounts of sterile water will cleanse the mouth after feeding. Formula or drainage is gently cleaned from the suture line with saline solution.

• #17 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Encourage frequent burping after feeding. When an infant drinks from a bottle, they can swallow some air, which goes down into their stomach along with the milk or formula. Burping will help to prevent aspiration after feeding. Following a feeding, be certain the infant with a cleft lip is burped well because the inability to securely grasp a nipple or syringe edge causes the infant to swallow more air than usual. […] Hold the infant upright or a sitting position while feeding. An upright or a sitting position improves swallowing and prevents milk from coming through the defect and out of the nasal cavity, therefore reducing the risk of aspiration. Therefore, the best feeding method for the infant diagnosed with cleft lip may be to support the infant in an upright position and feed the infant gently using a soft bottle and a commercial cleft lip nipple or a spoon.

• #18 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform parents that feeding should not last any longer than 20 to 30 minutes. Prolonged feedings may deplete an infant’s energy and cause fatigue. Infants may benefit from a learned rhythm during feedings. Pacing the feeding in rhythm with the infant’s reactions during feeding may increase the infant’s control of oral intake by helping maintain organization in sucking, swallowing, and breathing. […] Instruct in the use and care of pre-operative orthodontic devices (plastic palate mold) for an infant with cleft palate. This promotes the alignment of the maxilla and more normal speech sounds and prevents food from entering the nasal cavity. One issue that may remain is that because palate repair narrows the upper dental arch, a child may be left with less space in the upper jaw for the eruption of the teeth and would therefore require follow-up treatment by a pediatric dentist.

• #19 Cleft Lip and Palate Resources | Children’s Hospital Colorado

  https://www.childrenscolorado.org/doctors-and-departments/departments/cleft-program/resources/

  A feeding specialist can help choose the best feeding system and best methods to ensure the baby attains a safe and successful feeding. […] Its important that all babies get enough nutrition for growth and development. Medical professionals will decide when this type of feeding is necessary, such as: […] Its important to have your baby weighed (naked) every week for the first month to ensure theyre growing. Keeping a log of your babys feedings is also helpful to track how much theyre eating. […] After cleft lip surgery, within a few days after surgery, most babies can eat the way they were fed before the surgery. […] After cleft palate surgery, within a few days after surgery, most babies will go back to drinking the same amount of liquid as before the cleft palate surgery.

• #20 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  An alternative is for the mother to pump her breasts and feed the infant with a bottle. Pumping breast milk satisfies the mother’s desire to breastfeed and provides an excellent source of nourishment. Review with the mother how to pump or manually express breast milk to maintain a milk supply prior to surgical correction and after, if needed. […] Educate the mother regarding the different forms of feeders appropriate for the infant. Infants diagnosed with a cleft palate cannot suck effectively either because pressing their tongue or a nipple against the roof of their mouth forces the milk into their pharynx. The most successful method for feeding this infant is to use a commercial cleft palate nipple that has an extra flange of rubber to close the roof of the mouth. A Breck feeder may also be used to feed infants with a cleft palate.

• #21 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate parents about the possibility of solid food at the appropriate time. If the surgery is delayed beyond six months of age or the time when solid food would usually be introduced, teach the parents to be certain any food they offer is soft because particles of coarse food could invade the nasopharynx and be a cause of aspiration. […] Instruct the mother who bottle feeds to use some cereal to thicken the milk. Thicker milk will make swallowing easier due to the increased gravity flow brought about it. Additionally, the infant should be held during feedings or placed in an infant seat after feeding for a positive outcome. […] Offer small sips of fluid between feedings. If a cleft extends to the nares, so the nose and mouth are joined, breathing causes the oral mucous membranes and lips to become dry. Offering small sips of fluids between feedings can help keep the mucous membranes moist and prevent cracks and fissures that could lead to infection.

• #22 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Maintaining Airway Clearance and Preventing Aspiration […] Infants diagnosed with a cleft palate cannot suck effectively either because pressing their tongue or a nipple against the roof of their mouth forces milk into their pharynx, possibly leading to aspiration. Additionally, because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe children closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess the newborn’s respiratory rate, depth, and effort. Aspiration of secretions or milk may cause tachypnea. Newborns are obligate nose breathers and show signs of distress if their nostrils become obstructed. The newborn’s respiratory rate can be observed most easily by watching the newborn’s abdomen because breathing primarily involves using the diaphragm and abdominal muscles.

• #23 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Maintaining Airway Clearance and Preventing Aspiration […] Infants diagnosed with a cleft palate cannot suck effectively either because pressing their tongue or a nipple against the roof of their mouth forces milk into their pharynx, possibly leading to aspiration. Additionally, because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe children closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess the newborn’s respiratory rate, depth, and effort. Aspiration of secretions or milk may cause tachypnea. Newborns are obligate nose breathers and show signs of distress if their nostrils become obstructed. The newborn’s respiratory rate can be observed most easily by watching the newborn’s abdomen because breathing primarily involves using the diaphragm and abdominal muscles.

• #24 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess skin color and capillary refill. Bluish discoloration of the skin or prolonged capillary filling happens because of the decreased oxygenation produced by the defect. The nurse should note, however, that the peripheral circulation of a newborn remains sluggish for at least the first 24 hours, which can cause cyanosis in the infant’s feet and hands (acrocyanosis). […] Assess for abdominal distention. The infant may swallow excess air during bottle feeding, causing abdominal distention that may result in upward pressure on the diaphragm and lungs, compromising respiration. To facilitate palpation (if not contraindicated), the knees and legs should be flexed toward the hips, which allows the abdominal muscles to relax. […] Place the infant in an infant seat at 30 to 45. This position prevents the infant’s tongue from falling back and obstructing the airway. If possible, the infant can be placed in an infant bouncy seat. The semi-upright position facilitates burping, limits regurgitation of fluids, and prevents milk from entering the Eustachian tube and middle ear space, thus minimizing ear infections.

• #25 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess skin color and capillary refill. Bluish discoloration of the skin or prolonged capillary filling happens because of the decreased oxygenation produced by the defect. The nurse should note, however, that the peripheral circulation of a newborn remains sluggish for at least the first 24 hours, which can cause cyanosis in the infant’s feet and hands (acrocyanosis). […] Assess for abdominal distention. The infant may swallow excess air during bottle feeding, causing abdominal distention that may result in upward pressure on the diaphragm and lungs, compromising respiration. To facilitate palpation (if not contraindicated), the knees and legs should be flexed toward the hips, which allows the abdominal muscles to relax. […] Place the infant in an infant seat at 30 to 45. This position prevents the infant’s tongue from falling back and obstructing the airway. If possible, the infant can be placed in an infant bouncy seat. The semi-upright position facilitates burping, limits regurgitation of fluids, and prevents milk from entering the Eustachian tube and middle ear space, thus minimizing ear infections.

• #26 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Provide oral and nasal suctioning as needed. The purpose of suctioning is to maintain a patent airway and improve oxygenation by removing excess fluids and secretions in the oral and nasal cavities. Following either cleft lip or cleft palate surgery, infants may need their mouth suctioned to remove mucus, blood, and unswallowed saliva. When doing this, be exceedingly gentle, so you don’t touch the suture line with the catheter. Place the infant on their side to allow mouth secretions to drain forward. […] Feed the infant slowly and burp frequently. Burping frequently during feeding will reduce spitting up and prevent excessive swallowing of air. Holding the infant during feedings, burping frequently, and placing the infant in an infant seat after feeding or on the right side propped with a rolled blanket will aid in a positive outcome for this infant.

• #27 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Position the infant in an upright position greater than 60 during feeding and elevate the head of the crib to 30 after. General recommendations for body mechanics in infants with cleft lip or palate while feeding include the following: head support for neutral alignment of head and neck; arms forward, trunk midline, hips flexed; and lip, cheek, and jaw stabilization to provide a platform for sucking movements. Infants with cleft palate are fed in an upright position greater than 60 to allow gravity to facilitate fluid transfer and decrease the tendency for nasopharyngeal reflux. […] Allow the infant time to swallow during feedings and provide oral care as appropriate. Placing a small amount of breast milk or formula into the infant’s mouth and allowing time for swallowing will prevent aspiration. Offering small amounts of sterile water will cleanse the mouth after feeding. Formula or drainage is gently cleaned from the suture line with saline solution.

• #28 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Treatment consists of surgical repair, usually of the lip between 6 to 10 weeks of age, followed by the palate between 12 to 18 months of age. The surgical procedures depend on the child’s condition and physician preference. Management involves a multidisciplinary approach that includes the surgeon, pediatrician, nurse, orthodontist, prosthodontist, otolaryngologist, and speech therapist. […] Nursing goals for clients diagnosed with cleft lip and palate include maintaining adequate nutrition, increasing family coping, reducing the parents’ anxiety and guilt regarding the newborn’s physical defects, and preparing parents for the future repair of the cleft lip and palate. […] The following are the nursing priorities for patients with cleft lip and cleft palate: […] Feeding Difficulties. Infants with cleft lip and cleft palate may have difficulties in breastfeeding or bottle feeding due to structural abnormalities. Ensuring adequate nutrition and addressing feeding challenges are crucial for their growth and development.

• #29 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Cleft lip and cleft palate are separations in the upper lip and mouth that occur while a fetus develops in the uterus. Treating cleft lip and palate involves surgery and may include speech therapy and dental work. Your childs medical care team is there to support you each step of the way. […] Surgery can repair a cleft lip and/or cleft palate. […] Treatment for cleft lip and cleft palate begins at birth. Surgical treatment begins as early as 3 months and can last until the teen years. […] Surgery treats cleft lip and/or cleft palate. The exact details of treatment depend on the extent of the cleft, your childs age and other special needs or health conditions. Your child will have surgery at a hospital, under general anesthesia, so theyll be asleep during the procedure. […] A cleft lip repair may require one or two surgeries. The first surgery usually occurs when your baby is between 3 and 6 months old. This surgery closes their lip. The second surgery, if necessary, is usually done when your child is 6 months old.

• #30 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Cleft palate surgery usually occurs when your baby is 12 months old. It creates a working palate and reduces the chances that fluid will develop in your babys middle ears. […] Up to 40% of children with a cleft palate will need further surgeries to help improve their speech. […] Children often need treatment beyond surgery for cleft lip or palate. Some other treatments their healthcare providers may recommend are speech therapy and orthodontic treatment. […] Because of the number of oral health and medical problems associated with a cleft lip or cleft palate, it takes a team of healthcare providers working together to develop a comprehensive care plan. Your childs treatment usually begins in infancy and often continues through their early adulthood. […] You cant prevent your baby from having cleft lip/cleft palate. However, you may be able to lower the risk by not using cigarettes, alcohol and certain medications during pregnancy.

• #31 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess the parents’ ability to feed the infant with a defect and their knowledge about preoperative and postoperative needs and care. Education and support begin prenatally if the deformity is diagnosed in advance of delivery. A child born with a facial deformity encounters many problems. Feedings are difficult and may require special nipples. As the child grows, irregular tooth eruptions, drooling, delayed speech, and the need for intermittent hospitalization and frequent clinic appointments can be frustrating. […] Inform the parents of the general timing of surgical repair and what to expect from the neonate. Show them photographs of infants before and after surgical repair. If the infant’s weight is optimal and he has no other neonatal anomalies, he may undergo surgery to repair a cleft lip shortly after birth. Surgery may also occur in 2 to 3 months or as late as 8 months to allow for bonding and rule out other congenital anomalies. The cleft palate may be repaired in two steps by 12 to 16 months, or repair of the soft palate may proceed in 6 to 18 months and repair of the hard palate, as late as age 5. The timing of the procedures is related to normal growth changes, and repair usually takes place before speech development.

• #32 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform parents of usual ages for cleft lip repair and/or cleft palate, stages of surgery, and type of procedure performed. This provides information to reduce fear and anxiety and to know what to expect. If a cleft lip is discovered while the infant is still in utero, fetal surgery can repair the condition, although this procedure is not usually attempted. If the disorder is discovered at birth, a cleft lip can be repaired surgically shortly thereafter, often at the time of the initial hospital stay or between 2 and 12 weeks of age. […] Refer the parents to additional resources for necessary counseling and support. Referrals to community support groups may be useful from time to time to assist the parents in dealing with anxiety. Many communities have support groups for parents of children born with cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation is one such support group.

• #33 Cleft lip and cleft palate | PPT

  https://www.slideshare.net/slideshow/cleft-lip-and-cleft-palate-132828152/132828152

  Preoperative care: Keep the infant NPO for 6 hours before surgery. Administer premedication as per doctors order Physical, physiological, psychological and legal preparation should be done. […] […] Post operative care Keep the airway clear from accumulation of mucus in the nose and mouth. Mild sedation may be prescribed to prevent infant from crying. Careful positioning (never on the abdomen) Restraining the arms if necessary. […] […] The mouth should be rinsed with water before and after feeding. Do not brush the teeth 1-2 weeks after the surgery. The suture line must be cleaned gently with cotton or gauze-tipped swab dipped in hydrogen peroxide or saline solution and dried carefully several times a day to ensure proper healing. […] […] The parents are taught the ways by which injury to the palate can be prevented after discharge and prevention of upper respiratory tract infection. Speech therapy should be given. Encourage the child to socialize with family members and others. […]

• #34 Cleft lip and palate repair Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/surgery/cleft-lip-and-palate-repair

  Cleft lip and cleft palate repair is surgery to fix birth defects of the upper lip and palate (roof of the mouth). […] This type of surgery is done to correct a physical defect caused by a cleft lip or cleft palate. It is important to correct these conditions as they can cause problems with nursing, feeding, or speech. […] You will meet with a speech therapist or feeding therapist soon after your child is born. The therapist will help you find the best way to feed your child before the surgery. Your child must gain weight and be healthy before surgery. […] The surgery wound must be kept very clean as it heals. It must not be stretched or have any pressure put on it for 3 to 4 weeks. Your child’s nurse should show you how to take care of the wound. You will need to clean it with soap and water or a special cleaning liquid, and keep it moist with ointment.

• #35 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess suture lines for cleanliness, redness, swelling, or drainage frequency. This provides information indicating possible infection and the need for cleansing away formula or drainage. The incision line should appear clean and intact and free of erythema or drainage during the postoperative period. […] Assess for respiratory distress following palate surgery. This monitors breathing through a smaller airway caused by edema and breathing through the nose. Because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe the infant closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess for signs of infection such as fever, pain, pulling on an ear, or discharge from the ear. Review the signs of infection such as fever, pain, pulling on an ear, or discharge with the parents. Fever can be as high as 40C (104F). Infants’ earaches may manifest by general irritability, frequent rubbing or pulling at the ear and rolling of the head from side to side.

• #36 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Monitor lip protective device taped on operative site. This relaxes the site and prevents tension on sutures caused by facial movement or crying. After cleft lip surgery, the suture line may be held in close approximation by a Logan bar (a wire bow taped to both cheeks) or an adhesive bandage such as a Band-aid simulating a bar that brings together the incision line but does not cover the incision. Assess that this is secure and continues to protect the suture line from tension after each feeding or cleaning of the suture line. […] Perform strict care of the suture line. Infection and subsequent scarring may result if crusts from serous drainage are allowed to form on a cleft lip suture line. Most surgeons prescribe cleaning the suture line with sterile water or sterile saline with sterile cotton-tipped applicators after every feeding or whenever the normal serum that forms on suture lines accumulates.

• #37 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess suture lines for cleanliness, redness, swelling, or drainage frequency. This provides information indicating possible infection and the need for cleansing away formula or drainage. The incision line should appear clean and intact and free of erythema or drainage during the postoperative period. […] Assess for respiratory distress following palate surgery. This monitors breathing through a smaller airway caused by edema and breathing through the nose. Because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe the infant closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess for signs of infection such as fever, pain, pulling on an ear, or discharge from the ear. Review the signs of infection such as fever, pain, pulling on an ear, or discharge with the parents. Fever can be as high as 40C (104F). Infants’ earaches may manifest by general irritability, frequent rubbing or pulling at the ear and rolling of the head from side to side.

• #38 Cleft lip and palate repair Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/surgery/cleft-lip-and-palate-repair

  Cleft lip and cleft palate repair is surgery to fix birth defects of the upper lip and palate (roof of the mouth). […] This type of surgery is done to correct a physical defect caused by a cleft lip or cleft palate. It is important to correct these conditions as they can cause problems with nursing, feeding, or speech. […] You will meet with a speech therapist or feeding therapist soon after your child is born. The therapist will help you find the best way to feed your child before the surgery. Your child must gain weight and be healthy before surgery. […] The surgery wound must be kept very clean as it heals. It must not be stretched or have any pressure put on it for 3 to 4 weeks. Your child’s nurse should show you how to take care of the wound. You will need to clean it with soap and water or a special cleaning liquid, and keep it moist with ointment.

• #39 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Monitor lip protective device taped on operative site. This relaxes the site and prevents tension on sutures caused by facial movement or crying. After cleft lip surgery, the suture line may be held in close approximation by a Logan bar (a wire bow taped to both cheeks) or an adhesive bandage such as a Band-aid simulating a bar that brings together the incision line but does not cover the incision. Assess that this is secure and continues to protect the suture line from tension after each feeding or cleaning of the suture line. […] Perform strict care of the suture line. Infection and subsequent scarring may result if crusts from serous drainage are allowed to form on a cleft lip suture line. Most surgeons prescribe cleaning the suture line with sterile water or sterile saline with sterile cotton-tipped applicators after every feeding or whenever the normal serum that forms on suture lines accumulates.

• #40 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Monitor lip protective device taped on operative site. This relaxes the site and prevents tension on sutures caused by facial movement or crying. After cleft lip surgery, the suture line may be held in close approximation by a Logan bar (a wire bow taped to both cheeks) or an adhesive bandage such as a Band-aid simulating a bar that brings together the incision line but does not cover the incision. Assess that this is secure and continues to protect the suture line from tension after each feeding or cleaning of the suture line. […] Perform strict care of the suture line. Infection and subsequent scarring may result if crusts from serous drainage are allowed to form on a cleft lip suture line. Most surgeons prescribe cleaning the suture line with sterile water or sterile saline with sterile cotton-tipped applicators after every feeding or whenever the normal serum that forms on suture lines accumulates.

• #41 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Preventing Injury and Infections […] Cleft lip and cleft palate can lead to many complications. Early feeding difficulties limit the infant’s weight gain and growth and may lead to learning disabilities, speech disorders, recurring upper respiratory tract infections, and chronic ear disease. Abnormal anatomy of the orofacial cavity makes cleaning the maxillary incisors difficult, leading to higher dental caries rates. Early identification of complications and the prevention of several injury risks are keys to ensuring optimal healing and recovery of an infant or child diagnosed with cleft lip and/or palate and who underwent surgical repair. Changing the contour of the palate when it is repaired also changes the slope of the eustachian tube to the middle ear. This can lead to a high incidence of middle ear infection or otitis media because organisms are able to reach this area from the oral cavity more readily than usual.

• #42 After Cleft Lip or Palate Surgery | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/after-cleft-lip-or-palate-surgery

  Your baby or toddler recently had surgery to help fix their cleft lip, cleft palate, or both. As your child recovers, take these steps to help make sure that they heal correctly. […] Your child’s health care provider will tell you when to give your child medicine. If the pain medicine doesn’t seem to be working, let the provider know right away. […] Your child’s provider will prescribe antibiotics to prevent infection. Give your child the antibiotics exactly as instructed. […] To protect your child’s skin and help incision sites heal correctly: Keep the incision sites as dry as possible. Regular, gentle patting of the mouth with a clean cloth can help. […] Don’t put any cream or lotion on the incisions unless directed to do so. […] Keep your child’s hands away from the incisions. To do so, you may need to use gentle restraints on your child’s arms for 7 to 10 days after surgery. Nursing staff will show you how to do this safely.

• #43 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess suture lines for cleanliness, redness, swelling, or drainage frequency. This provides information indicating possible infection and the need for cleansing away formula or drainage. The incision line should appear clean and intact and free of erythema or drainage during the postoperative period. […] Assess for respiratory distress following palate surgery. This monitors breathing through a smaller airway caused by edema and breathing through the nose. Because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe the infant closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess for signs of infection such as fever, pain, pulling on an ear, or discharge from the ear. Review the signs of infection such as fever, pain, pulling on an ear, or discharge with the parents. Fever can be as high as 40C (104F). Infants’ earaches may manifest by general irritability, frequent rubbing or pulling at the ear and rolling of the head from side to side.

• #44 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess suture lines for cleanliness, redness, swelling, or drainage frequency. This provides information indicating possible infection and the need for cleansing away formula or drainage. The incision line should appear clean and intact and free of erythema or drainage during the postoperative period. […] Assess for respiratory distress following palate surgery. This monitors breathing through a smaller airway caused by edema and breathing through the nose. Because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe the infant closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess for signs of infection such as fever, pain, pulling on an ear, or discharge from the ear. Review the signs of infection such as fever, pain, pulling on an ear, or discharge with the parents. Fever can be as high as 40C (104F). Infants’ earaches may manifest by general irritability, frequent rubbing or pulling at the ear and rolling of the head from side to side.

• #45 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Provide ordered analgesics for pain, hold, cuddle, or rock child, anticipate needs to prevent crying. Furnish adequate pain relief, so the infant does not cry because this puts increased tension on the sutures. To help avoid crying, try to anticipate the infant’s needs by having formula ready to feed. Help the parents use whatever measures, such as rocking, carrying, or holding, that are necessary to make the infant feel secure and comfortable. […] Apply soft elbow restraints and remove periodically to perform ROM on arms and allow for movement and holding; a child may need a jacket restraint to prevent rolling over. This prevents the child from touching or injuring the operative site. Keep elbow restraints in place as necessary, so they do not put their fingers in their mouth and poke or pull at the sutures.

• #46 Cleft Palate Repair: Instructions After Surgery

  https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/cleft-palate-repair-instructions-after-surgery

  Your child’s cleft palate has been repaired. The opening in the roof of the mouth is now closed. Following surgery, there are a few things to know about your child’s care at home. Other than these special instructions, your child should be cared for in the same way as any other child the same age. […] The Cleft Lip and Palate Center expertly cares for children with cleft palate. […] The roof of your child’s mouth (the palate) is still healing and should be protected from injury for about 3 weeks after surgery. […] Your child may or may not need to wear arm splints for 3 weeks. Please discuss this with your surgeon. These splints keep your child from putting their fingers into the mouth and accidentally damaging the repair. […] It is important for your child to take medicines as directed by the doctor. Your child will go home with an antibiotic. The antibiotic needs to be taken until all of it is gone.

• #47 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Visualize the inner ear and palpate the mastoid process. With an infection, the tympanic membrane appears inflamed or reddened. It may bulge forward into the external canal because of fluid and edema behind it. Palpate the mastoid process behind the ear to be certain it doesn’t feel tender to your touch. If it does, the infection probably has spread out of the middle ear into the mastoid cells, a serious complication that may lead to meningitis. […] Screen the infant/child for hearing loss. The child needs to be screened for hearing difficulty because the angle of the eustachian tube may be changed in surgery, and they may develop more ear infections than usual, which can possibly lead to some hearing impairment. Hearing loss may impair cognitive and language development, which can hamper the education and communication abilities of the developing child.

• #48 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Explain to parents that usual feeding patterns may be resumed in 2 weeks for lip repair or in 4 to 6 weeks for palate repair. This provides an estimated time based on suture removal and healing to resume regular bottle feeding or return to baseline dietary status. The infant receives feedings by dropper until the wound is completely healed (1 to 2 weeks). Care should be taken to avoid touching the suture line when inserting the medicine dropper. […] Refer parents and the child to appropriate professional resources after discharge. Children diagnosed with cleft problems tend to receive better, more frequent, and well-coordinated care when seen in an interprofessional team setting, including pediatric dentists, audiologists, speech pathologists, geneticists, and craniofacial surgeons, so referring parents to an appropriate interprofessional center before discharge is critical for these infants and their families.

• #49 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Refrain from removing the bottle nipple from the infant’s mouth unless necessary. Removing the nipple may cause the infant to cry, making feeding more challenging. The infant should also be prevented from crying postoperatively because it could cause tension on the suture line. Care should be taken to avoid touching the suture line when inserting the nipple of a bottle or of the medicine dropper. […] Keep the infant NPO after the surgery and gradually introduce appropriate diets. After surgery for cleft lip or palate, an infant is kept nothing by mouth (NPO) for approximately 4 hours and then introduced to liquids such as plain water. Be certain to begin this process with only a small amount each time to prevent vomiting. After palate surgery, only liquids are generally given for the first 3 or 4 days, followed by a soft diet until healing is complete.

• #50 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Avoid feeding milk post-surgery. Be certain milk is not included in the first fluids offered because milk curds tend to adhere to the suture line and are difficult to remove. After a feeding, always offer the child a sip of clear water to rinse the suture line and keep it as clean as possible. […] Instruct the parents regarding oral care. Educate the parents to be diligent about oral health care. In infants with clefts involving the maxillary alveolar ridge (upper gum), it is common for some teeth to be misshapen or turned. Prudent twice-daily gum and teeth brushing with an age-appropriate toothbrush and toothpaste are crucial, as are bi-yearly dental visits for monitoring. […] Reducing Anxiety and Enhancing Coping […] A mother’s first reaction to a disfigured newborn is one of shock, hurt, disappointment, and guilt. Some parents may regard the deformity as a result of their inadequacies. They may desire to hide the child from relatives and friends. The client and the family need understanding, a concrete basis for hope, and practical advice. Family stress often occurs because of the multiple surgeries that may be required throughout childhood.

• #51 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Remove sharp objects or toys, and avoid the use of forks, straws, or other pointed objects. Nothing hard or sharp must come in contact with a recent cleft suture line. Observe the infant after palate repair carefully, therefore, to be certain they do not put toys with sharp edges into their mouths. It’s also good practice to not allow them to use a straw to drink or hold a toothbrush to clean their teeth, so they don’t brush the suture line accidentally. […] Feed with a cup or spoon if palate repair was done; avoid placing a spoon in the mouth. When the child begins to eat soft food, observe that they don’t use a spoon because spoons can invariably be pushed against the roof of their mouth and possibly disrupt sutures. If being fed rather than allowing the infant to use a spoon invokes an intense reaction, it is probably better to leave a child on a liquid diet until the sutures are removed.

• #52 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate parents about the possibility of solid food at the appropriate time. If the surgery is delayed beyond six months of age or the time when solid food would usually be introduced, teach the parents to be certain any food they offer is soft because particles of coarse food could invade the nasopharynx and be a cause of aspiration. […] Instruct the mother who bottle feeds to use some cereal to thicken the milk. Thicker milk will make swallowing easier due to the increased gravity flow brought about it. Additionally, the infant should be held during feedings or placed in an infant seat after feeding for a positive outcome. […] Offer small sips of fluid between feedings. If a cleft extends to the nares, so the nose and mouth are joined, breathing causes the oral mucous membranes and lips to become dry. Offering small sips of fluids between feedings can help keep the mucous membranes moist and prevent cracks and fissures that could lead to infection.

• #53 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Avoid feeding milk post-surgery. Be certain milk is not included in the first fluids offered because milk curds tend to adhere to the suture line and are difficult to remove. After a feeding, always offer the child a sip of clear water to rinse the suture line and keep it as clean as possible. […] Instruct the parents regarding oral care. Educate the parents to be diligent about oral health care. In infants with clefts involving the maxillary alveolar ridge (upper gum), it is common for some teeth to be misshapen or turned. Prudent twice-daily gum and teeth brushing with an age-appropriate toothbrush and toothpaste are crucial, as are bi-yearly dental visits for monitoring. […] Reducing Anxiety and Enhancing Coping […] A mother’s first reaction to a disfigured newborn is one of shock, hurt, disappointment, and guilt. Some parents may regard the deformity as a result of their inadequacies. They may desire to hide the child from relatives and friends. The client and the family need understanding, a concrete basis for hope, and practical advice. Family stress often occurs because of the multiple surgeries that may be required throughout childhood.

• #54 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Advise parents not to allow the child to play with small toys or those that are sharp or require sucking or blowing; suggest soft, stuffed toys for an infant. This removes the possibility of placing a toy in the mouth or damaging an incision. Observe the infant after palate repair carefully to be certain they do not put toys with sharp edges into their mouths. The nurse should also teach the parents to keep objects such as the child’s thumb, tongue blades, toast, cookies, forks, and pacifiers out of the mouth. […] Position the infant in an upright position during feeding. Infants who underwent cleft palate repair are fed in an upright position greater than 60 to allow gravity to facilitate fluid transfer and prevent milk from entering the eustachian tube and middle ear space, thus minimizing ear infections.

• #55 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Explain to parents that usual feeding patterns may be resumed in 2 weeks for lip repair or in 4 to 6 weeks for palate repair. This provides an estimated time based on suture removal and healing to resume regular bottle feeding or return to baseline dietary status. The infant receives feedings by dropper until the wound is completely healed (1 to 2 weeks). Care should be taken to avoid touching the suture line when inserting the medicine dropper. […] Refer parents and the child to appropriate professional resources after discharge. Children diagnosed with cleft problems tend to receive better, more frequent, and well-coordinated care when seen in an interprofessional team setting, including pediatric dentists, audiologists, speech pathologists, geneticists, and craniofacial surgeons, so referring parents to an appropriate interprofessional center before discharge is critical for these infants and their families.

• #56 Cleft Lip and Cleft Palate Nursing Care Management

  https://nurseslabs.com/cleft-lip-cleft-palate/

  Cleft lip and cleft palate can be emotionally challenging for affected individuals and their families, necessitating comprehensive and multidisciplinary care from healthcare professionals. […] A complete and thorough process of care should be undergone by the newborn with cleft lip and cleft palate. […] One primary concern in the nursing care of a newborn with a cleft lip and cleft palate is the emotional care of the newborn’s family. […] Based on the assessment data, the major nursing diagnoses are: Compromised family coping related to visible physical defect. […] Goal setting and planning must be modified to adapt to the surgical plans; the major goals include: Maintaining adequate nutrition. […] Nursing interventions for the patient with cleft lip and palate are: Maintain adequate nutrition.

• #57 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Avoid feeding milk post-surgery. Be certain milk is not included in the first fluids offered because milk curds tend to adhere to the suture line and are difficult to remove. After a feeding, always offer the child a sip of clear water to rinse the suture line and keep it as clean as possible. […] Instruct the parents regarding oral care. Educate the parents to be diligent about oral health care. In infants with clefts involving the maxillary alveolar ridge (upper gum), it is common for some teeth to be misshapen or turned. Prudent twice-daily gum and teeth brushing with an age-appropriate toothbrush and toothpaste are crucial, as are bi-yearly dental visits for monitoring. […] Reducing Anxiety and Enhancing Coping […] A mother’s first reaction to a disfigured newborn is one of shock, hurt, disappointment, and guilt. Some parents may regard the deformity as a result of their inadequacies. They may desire to hide the child from relatives and friends. The client and the family need understanding, a concrete basis for hope, and practical advice. Family stress often occurs because of the multiple surgeries that may be required throughout childhood.

• #58 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess the level of anxiety and need for information. This provides information to allay anxiety manifested by the infant’s appearance at birth with a level increased with the location and extent of the defect. Children can be affected by the fear experienced by their parents, thus magnifying the psychological impact on the child. […] Assess family coping methods used and their effectiveness. This provides information about coping methods and the need to develop new coping skills. Family attitudes directly affect a child’s feeling of self-worth, and a child with special needs may strengthen or strain family relationships. […] Observe the parents’ interaction with the infant. Observe whether the parents look at their infant’s face while feeding or caring for the infant. This helps identify the parents’ acceptance of the infant’s condition and helps them progress toward the improvement of their coping skills.

• #59 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess the level of anxiety and need for information. This provides information to allay anxiety manifested by the infant’s appearance at birth with a level increased with the location and extent of the defect. Children can be affected by the fear experienced by their parents, thus magnifying the psychological impact on the child. […] Assess family coping methods used and their effectiveness. This provides information about coping methods and the need to develop new coping skills. Family attitudes directly affect a child’s feeling of self-worth, and a child with special needs may strengthen or strain family relationships. […] Observe the parents’ interaction with the infant. Observe whether the parents look at their infant’s face while feeding or caring for the infant. This helps identify the parents’ acceptance of the infant’s condition and helps them progress toward the improvement of their coping skills.

• #60 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess the level of anxiety and need for information. This provides information to allay anxiety manifested by the infant’s appearance at birth with a level increased with the location and extent of the defect. Children can be affected by the fear experienced by their parents, thus magnifying the psychological impact on the child. […] Assess family coping methods used and their effectiveness. This provides information about coping methods and the need to develop new coping skills. Family attitudes directly affect a child’s feeling of self-worth, and a child with special needs may strengthen or strain family relationships. […] Observe the parents’ interaction with the infant. Observe whether the parents look at their infant’s face while feeding or caring for the infant. This helps identify the parents’ acceptance of the infant’s condition and helps them progress toward the improvement of their coping skills.

• #61 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Determine the parents’ current knowledge and perception of the situation. The lack of information or unrealistic expectations can interfere with family members and the client’s response to the defect and the situation. […] Encourage expressing concerns and questions about the condition to discuss feelings about the infant’s appearance. This provides an environment conducive to venting feelings to facilitate the adjustment to the infant’s defect. It also provides an opportunity to examine realistic fears and misconceptions about the condition. […] Provide an accepting environment and attitude and handle the infant in a gentle, caring way. This promotes trust and conveys to parents that an infant is a valuable human baby deserving of love and caring. Provide an open environment wherein the parents, and the child feel accepted in their present condition without feeling judged and can promote a sense of dignity and control.

• #62 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Determine the parents’ current knowledge and perception of the situation. The lack of information or unrealistic expectations can interfere with family members and the client’s response to the defect and the situation. […] Encourage expressing concerns and questions about the condition to discuss feelings about the infant’s appearance. This provides an environment conducive to venting feelings to facilitate the adjustment to the infant’s defect. It also provides an opportunity to examine realistic fears and misconceptions about the condition. […] Provide an accepting environment and attitude and handle the infant in a gentle, caring way. This promotes trust and conveys to parents that an infant is a valuable human baby deserving of love and caring. Provide an open environment wherein the parents, and the child feel accepted in their present condition without feeling judged and can promote a sense of dignity and control.

• #63 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Determine the parents’ current knowledge and perception of the situation. The lack of information or unrealistic expectations can interfere with family members and the client’s response to the defect and the situation. […] Encourage expressing concerns and questions about the condition to discuss feelings about the infant’s appearance. This provides an environment conducive to venting feelings to facilitate the adjustment to the infant’s defect. It also provides an opportunity to examine realistic fears and misconceptions about the condition. […] Provide an accepting environment and attitude and handle the infant in a gentle, caring way. This promotes trust and conveys to parents that an infant is a valuable human baby deserving of love and caring. Provide an open environment wherein the parents, and the child feel accepted in their present condition without feeling judged and can promote a sense of dignity and control.

• #64 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Communicate with parents in a calm and honest way. This promotes a calm and supportive environment to reduce anxiety and instill hope. Provide accurate and consistent information to reduce the parents’ anxiety and enable them to make decisions and choices based on realities. […] Assist the family or parents in recognizing or clarifying fears to begin developing coping strategies for dealing with these fears. Coping skills are often stressed after diagnosis and during the different phases of treatment. Support and counseling are often necessary to enable the parents to recognize and deal with fear and to realize that control and coping strategies are available. […] Allow parents to stay with the infant and encourage them to assist in care as appropriate. This reduces anxiety and promotes bonding that may be blocked by an infant’s appearance. It is equally important from a psychological standpoint as a parent may need caring support to bond with an infant whose face is deformed in this way.

• #65 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Communicate with parents in a calm and honest way. This promotes a calm and supportive environment to reduce anxiety and instill hope. Provide accurate and consistent information to reduce the parents’ anxiety and enable them to make decisions and choices based on realities. […] Assist the family or parents in recognizing or clarifying fears to begin developing coping strategies for dealing with these fears. Coping skills are often stressed after diagnosis and during the different phases of treatment. Support and counseling are often necessary to enable the parents to recognize and deal with fear and to realize that control and coping strategies are available. […] Allow parents to stay with the infant and encourage them to assist in care as appropriate. This reduces anxiety and promotes bonding that may be blocked by an infant’s appearance. It is equally important from a psychological standpoint as a parent may need caring support to bond with an infant whose face is deformed in this way.

• #66 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Communicate with parents in a calm and honest way. This promotes a calm and supportive environment to reduce anxiety and instill hope. Provide accurate and consistent information to reduce the parents’ anxiety and enable them to make decisions and choices based on realities. […] Assist the family or parents in recognizing or clarifying fears to begin developing coping strategies for dealing with these fears. Coping skills are often stressed after diagnosis and during the different phases of treatment. Support and counseling are often necessary to enable the parents to recognize and deal with fear and to realize that control and coping strategies are available. […] Allow parents to stay with the infant and encourage them to assist in care as appropriate. This reduces anxiety and promotes bonding that may be blocked by an infant’s appearance. It is equally important from a psychological standpoint as a parent may need caring support to bond with an infant whose face is deformed in this way.

• #67 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Emphasize the infant’s positive features when providing information. This promotes positive feelings for the infant. The developing child senses the parents’ feelings and acquires either a positive or a negative self-image. The client and family need understanding, a concrete basis for hope, and practical advice. […] Explain procedures and stay with the family during anxiety-producing procedures and consultations, as appropriate. Accurate information allows the parents or family to deal more effectively with the reality of the situation, thereby reducing anxiety and fear of the unknown. […] Suggest visits with parents who have a child with a similar defect and were successfully repaired, or show them photos. This provides support and information to reduce anxiety. The surgical repair of cleft lip and palate results is currently excellent. It is also helpful to show parents photographs of infants with good repairs to assure their child’s outcome can be successful.

• #68 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Emphasize the infant’s positive features when providing information. This promotes positive feelings for the infant. The developing child senses the parents’ feelings and acquires either a positive or a negative self-image. The client and family need understanding, a concrete basis for hope, and practical advice. […] Explain procedures and stay with the family during anxiety-producing procedures and consultations, as appropriate. Accurate information allows the parents or family to deal more effectively with the reality of the situation, thereby reducing anxiety and fear of the unknown. […] Suggest visits with parents who have a child with a similar defect and were successfully repaired, or show them photos. This provides support and information to reduce anxiety. The surgical repair of cleft lip and palate results is currently excellent. It is also helpful to show parents photographs of infants with good repairs to assure their child’s outcome can be successful.

• #69 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform parents of usual ages for cleft lip repair and/or cleft palate, stages of surgery, and type of procedure performed. This provides information to reduce fear and anxiety and to know what to expect. If a cleft lip is discovered while the infant is still in utero, fetal surgery can repair the condition, although this procedure is not usually attempted. If the disorder is discovered at birth, a cleft lip can be repaired surgically shortly thereafter, often at the time of the initial hospital stay or between 2 and 12 weeks of age. […] Refer the parents to additional resources for necessary counseling and support. Referrals to community support groups may be useful from time to time to assist the parents in dealing with anxiety. Many communities have support groups for parents of children born with cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation is one such support group.

• #70 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform parents of usual ages for cleft lip repair and/or cleft palate, stages of surgery, and type of procedure performed. This provides information to reduce fear and anxiety and to know what to expect. If a cleft lip is discovered while the infant is still in utero, fetal surgery can repair the condition, although this procedure is not usually attempted. If the disorder is discovered at birth, a cleft lip can be repaired surgically shortly thereafter, often at the time of the initial hospital stay or between 2 and 12 weeks of age. […] Refer the parents to additional resources for necessary counseling and support. Referrals to community support groups may be useful from time to time to assist the parents in dealing with anxiety. Many communities have support groups for parents of children born with cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation is one such support group.

• #71 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Encourage family members to express problem areas and explore solutions together. This reduces anxiety, enhances understanding, and provides an opportunity to identify problems and problem-solving strategies. Help them understand that any negative feelings they feel toward the infant or themselves, such as sadness or anger, are normal. This assurance does not instantly make them feel better about what has happened, but the knowledge the feelings they are experiencing are normal can help them begin to deal with such emotions. […] Assist family members in identifying three healthy coping mechanisms they can use. This empowers the family to find the solution appropriate for them. Recognizing one’s own strengths and areas for improvement provides an opportunity for personal growth, enhancing the potential for success once the infant returns home with the parents.

• #72 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Provide instructions when complications are identified at home. Ear infections and dental decay may accompany cleft palate. Parents are instructed to take the child to the health care provider at the first sign of earache. […] Initiating Patient Education and Health Teachings […] Mothers of infants diagnosed with cleft lip and palate may have limited knowledge about feeding their infants and may lack information regarding regurgitation, colic, and swallowing during feedings. Mothers may feel stressed or confused when various healthcare professionals provide conflicting feeding suggestions. Feeding instructions help parents develop confidence in properly caring for their infant diagnosed with cleft lip and palate. […] Assess the presence of acceptance of methods used by parents and their knowledge of the cause and type of defects. This provides information about a defect that may be inherited or congenital, partial or complete, unilateral or bilateral cleft of the lip and/or palate, adequate nutritional status, and freedom from infection before surgery is done.

• #73 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Provide instructions when complications are identified at home. Ear infections and dental decay may accompany cleft palate. Parents are instructed to take the child to the health care provider at the first sign of earache. […] Initiating Patient Education and Health Teachings […] Mothers of infants diagnosed with cleft lip and palate may have limited knowledge about feeding their infants and may lack information regarding regurgitation, colic, and swallowing during feedings. Mothers may feel stressed or confused when various healthcare professionals provide conflicting feeding suggestions. Feeding instructions help parents develop confidence in properly caring for their infant diagnosed with cleft lip and palate. […] Assess the presence of acceptance of methods used by parents and their knowledge of the cause and type of defects. This provides information about a defect that may be inherited or congenital, partial or complete, unilateral or bilateral cleft of the lip and/or palate, adequate nutritional status, and freedom from infection before surgery is done.

• #74 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach and observe parents hold the infant while feeding in the appropriate position and using the appropriate feeding devices. Holding the head upright reduces the possibility of aspiration. The positioning includes the head’s support, the midline trunk, and the hips slightly flexed. Special nipples or devices are used because the cleft interferes with the ability to suck and liquid often flows into the nose when taken into the mouth. The act of breastfeeding encourages the normal physiological muscular movement and coordination of the mouth and face. […] Teach and observe to feed slowly and in small amounts, burping frequently, and extend the nipple or feeding device well back into the mouth. This prevents choking, abdominal distention, a possible liquid flow into the nose, or aspiration into the lungs, causing pneumonia, otitis media, or upper respiratory infections. Following a feeding, be certain the infant with a cleft lip is burped well because the inability to securely grasp a nipple or syringe edge causes the infant to swallow more air than usual.

• #75 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach and observe parents hold the infant while feeding in the appropriate position and using the appropriate feeding devices. Holding the head upright reduces the possibility of aspiration. The positioning includes the head’s support, the midline trunk, and the hips slightly flexed. Special nipples or devices are used because the cleft interferes with the ability to suck and liquid often flows into the nose when taken into the mouth. The act of breastfeeding encourages the normal physiological muscular movement and coordination of the mouth and face. […] Teach and observe to feed slowly and in small amounts, burping frequently, and extend the nipple or feeding device well back into the mouth. This prevents choking, abdominal distention, a possible liquid flow into the nose, or aspiration into the lungs, causing pneumonia, otitis media, or upper respiratory infections. Following a feeding, be certain the infant with a cleft lip is burped well because the inability to securely grasp a nipple or syringe edge causes the infant to swallow more air than usual.

• #76 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform parents that feeding should not last any longer than 20 to 30 minutes. Prolonged feedings may deplete an infant’s energy and cause fatigue. Infants may benefit from a learned rhythm during feedings. Pacing the feeding in rhythm with the infant’s reactions during feeding may increase the infant’s control of oral intake by helping maintain organization in sucking, swallowing, and breathing. […] Instruct in the use and care of pre-operative orthodontic devices (plastic palate mold) for an infant with cleft palate. This promotes the alignment of the maxilla and more normal speech sounds and prevents food from entering the nasal cavity. One issue that may remain is that because palate repair narrows the upper dental arch, a child may be left with less space in the upper jaw for the eruption of the teeth and would therefore require follow-up treatment by a pediatric dentist.

• #77 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Instruct parents to cleanse the lip, oral cavity, and nose with water before and after feeding. This prevents infection or skin breakdown with cleft lip or palate. Offering small sips of fluid between feedings can help keep the mucous membranes moist and prevent cracks and fissures that could lead to infection. […] Teach parents to avoid the prone position and place the child on the back or side. This prepares the child for treatments that will be done postoperatively. Following a cleft lip repair, be sure that the infant does not turn onto their abdomen because this could put pressure on the suture line, possibly tearing it. Placing the child in an infant bouncy chair is another possibility. […] Inform parents of procedures for correcting defects, medications, procedures to prepare the infant for surgery, and what to expect postoperatively. This prepares the parents for surgical correction of defects and what to expect during convalescence. Because facial contours change as a child grows, a revision of the original septum may be necessary when the child reaches 4 to 6 years of age. Some infants may have a nasal mold apparatus applied before surgery to shape a better nostril.

• #78 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Instruct parents to cleanse the lip, oral cavity, and nose with water before and after feeding. This prevents infection or skin breakdown with cleft lip or palate. Offering small sips of fluid between feedings can help keep the mucous membranes moist and prevent cracks and fissures that could lead to infection. […] Teach parents to avoid the prone position and place the child on the back or side. This prepares the child for treatments that will be done postoperatively. Following a cleft lip repair, be sure that the infant does not turn onto their abdomen because this could put pressure on the suture line, possibly tearing it. Placing the child in an infant bouncy chair is another possibility. […] Inform parents of procedures for correcting defects, medications, procedures to prepare the infant for surgery, and what to expect postoperatively. This prepares the parents for surgical correction of defects and what to expect during convalescence. Because facial contours change as a child grows, a revision of the original septum may be necessary when the child reaches 4 to 6 years of age. Some infants may have a nasal mold apparatus applied before surgery to shape a better nostril.

• #79 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Instruct parents to cleanse the lip, oral cavity, and nose with water before and after feeding. This prevents infection or skin breakdown with cleft lip or palate. Offering small sips of fluid between feedings can help keep the mucous membranes moist and prevent cracks and fissures that could lead to infection. […] Teach parents to avoid the prone position and place the child on the back or side. This prepares the child for treatments that will be done postoperatively. Following a cleft lip repair, be sure that the infant does not turn onto their abdomen because this could put pressure on the suture line, possibly tearing it. Placing the child in an infant bouncy chair is another possibility. […] Inform parents of procedures for correcting defects, medications, procedures to prepare the infant for surgery, and what to expect postoperatively. This prepares the parents for surgical correction of defects and what to expect during convalescence. Because facial contours change as a child grows, a revision of the original septum may be necessary when the child reaches 4 to 6 years of age. Some infants may have a nasal mold apparatus applied before surgery to shape a better nostril.

• #80 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Accompany the child when playing or ambulating. This prevents trauma caused by accidental falls and prevents crying as much as possible. Play should be quiet, particularly in the immediate postoperative period. The nurse may instruct the parents to provide reading, drawing, or coloring materials. […] Teach parents about cleansing suture sites and applying antibiotic ointment. Let the parents perform a return demonstration after. This prevents infection and enhances comfort and healing. Instruct them not to rub the suture line and use a smooth, gentle, rolling motion to avoid loosening the sutures. Teach them to gently dry the suture line with a dry sterile cotton-tipped applicator afterward. Remember that the infant has sutures on the lip that need the same meticulous care as those visible on the outside.

• #81 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach parents feeding methods for the infant and allow them to practice appropriate techniques using a syringe soft tube in the mouth away from any suture line or a cup for an older child. This promotes nutrition following surgery without sucking on a nipple. Specialized feeding bottles can make feeding easier for the infant by reducing the need to generate high negative pressures. In at least one study, infants diagnosed with cleft lip and palate with compressible bottles gained more weight and required less intervention compared with infants using rigid bottles. […] Provide diversional activities suitable for the child’s developmental age and situation. Sutures on the lip or palate feel extremely odd, so most children not only run their tongue over their sutures but also don’t respond to advice not to do this. Because this often occurs when children have nothing to think about, help the parents provide diversional activities such as reading or singing to keep the child’s attention off the suture line.

• #82 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Advise parents not to allow the child to play with small toys or those that are sharp or require sucking or blowing; suggest soft, stuffed toys for an infant. This removes the possibility of placing a toy in the mouth or damaging an incision. Observe the infant after palate repair carefully to be certain they do not put toys with sharp edges into their mouths. The nurse should also teach the parents to keep objects such as the child’s thumb, tongue blades, toast, cookies, forks, and pacifiers out of the mouth. […] Position the infant in an upright position during feeding. Infants who underwent cleft palate repair are fed in an upright position greater than 60 to allow gravity to facilitate fluid transfer and prevent milk from entering the eustachian tube and middle ear space, thus minimizing ear infections.

• #83 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate the parents regarding signs and symptoms of complications that are needed to be reported immediately. Remind the parents of the importance of recognizing and reporting signs of pharyngeal infection to their primary care provider promptly so it can be treated before the infection spreads to the middle ear. […] Apply a warm or cold compress to decrease pain and promote comfort. A warm compress may be applied locally to increase the child’s comfort. Cold may also be beneficial. An ice pack may be prescribed to reduce edema and pressure. […] Instruct the parents never to insert anything into the child’s ear. Parents are instructed not to insert cotton swabs or any object into the child’s ears, especially when cleaning. These objects may rupture the tympanic membrane, further complicating the child’s ear infection.

• #84 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate the parents regarding signs and symptoms of complications that are needed to be reported immediately. Remind the parents of the importance of recognizing and reporting signs of pharyngeal infection to their primary care provider promptly so it can be treated before the infection spreads to the middle ear. […] Apply a warm or cold compress to decrease pain and promote comfort. A warm compress may be applied locally to increase the child’s comfort. Cold may also be beneficial. An ice pack may be prescribed to reduce edema and pressure. […] Instruct the parents never to insert anything into the child’s ear. Parents are instructed not to insert cotton swabs or any object into the child’s ears, especially when cleaning. These objects may rupture the tympanic membrane, further complicating the child’s ear infection.

• #85 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate parents regarding the importance of future dental follow-up consultations. One issue that may remain is that because palate repair narrows the upper dental arch, a child may be left with less space in the upper jaw for the eruption of teeth, creating poor teeth alignment. All children born with a cleft palate need follow-up treatment by a pediatric dentist skilled in children’s dental problems so that as the child grows, extractions or realignment of teeth can be done as indicated. […] Inform the parents about the importance of consulting with a speech therapist. Children also need follow-up to detect if speech difficulty occurs. After surgical repair, about 80% of children affected by cleft palate progress to develop normal speech, yet referral to speech therapy early in infancy should always occur to ensure successful speech development.

• #86 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate parents regarding the importance of future dental follow-up consultations. One issue that may remain is that because palate repair narrows the upper dental arch, a child may be left with less space in the upper jaw for the eruption of teeth, creating poor teeth alignment. All children born with a cleft palate need follow-up treatment by a pediatric dentist skilled in children’s dental problems so that as the child grows, extractions or realignment of teeth can be done as indicated. […] Inform the parents about the importance of consulting with a speech therapist. Children also need follow-up to detect if speech difficulty occurs. After surgical repair, about 80% of children affected by cleft palate progress to develop normal speech, yet referral to speech therapy early in infancy should always occur to ensure successful speech development.

• #87 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform the parents about the importance of routine screening for hearing loss. Be certain the parents understand the need for routine screening for hearing loss during childhood because this is a common early sign of serous otitis media. All children should be followed up to make sure that the condition is resolved and to evaluate any hearing loss that may have occurred. […] Administer analgesics and antipyretics as prescribed. The child may need analgesics and antipyretics such as acetaminophen and decongestant nose drops to open the eustachian tubes and allow air to enter the middle ear. These are given for only 2 to 3 days because if they are given longer, a rebound effect can occur, causing edema and a subsequent increase in mucous membrane inflammation. Instruct the parents to administer acetaminophen every 4 hours or ibuprofen every 8 hours as prescribed.

• #88

  https://www.healthychildren.org/English/health-issues/conditions/Cleft-Craniofacial/Pages/Cleft-Lip-and-Palate-Parent-FAQs.aspx

  A newborn should see their cleft/craniofacial team within one week (or as soon as possible) from the day they first leave the hospital. In the beginning, the team will make sure the baby is feeding and growing well. […] Surgical repair of a child’s cleft is one part of the care that the cleft/craniofacial team provides. […] The AAP recommends initial reconstructive surgeries for cleft lip or cleft palate occur within the first year of life. […] Children with cleft lip and/or cleft palate often need additional surgeries and treatments as they grow. For example, they may need braces during childhood. Each child will need different numbers and types of surgeries why individualized coordination of care is so important. Most children born with clefts will need regular visits to their cleft/craniofacial team until they are adults.

• #89 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Offer the parents information regarding home care and community resources. In large cities, special cleft palate clinics are available where several specialists can collaborate in convenient consultation. The parents are instructed about the resources available in the state in which they live. The American Cleft Palate-Craniofacial Association, the Cleft Palate Foundation, the March of Dimes Birth Defect Foundation, and state programs for children with special needs are examples of community referrals that should be offered to parents.

• #90 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Cleft palate surgery usually occurs when your baby is 12 months old. It creates a working palate and reduces the chances that fluid will develop in your babys middle ears. […] Up to 40% of children with a cleft palate will need further surgeries to help improve their speech. […] Children often need treatment beyond surgery for cleft lip or palate. Some other treatments their healthcare providers may recommend are speech therapy and orthodontic treatment. […] Because of the number of oral health and medical problems associated with a cleft lip or cleft palate, it takes a team of healthcare providers working together to develop a comprehensive care plan. Your childs treatment usually begins in infancy and often continues through their early adulthood. […] You cant prevent your baby from having cleft lip/cleft palate. However, you may be able to lower the risk by not using cigarettes, alcohol and certain medications during pregnancy.

• #91 Cleft Lip & Palate – Division of Plastic and Reconstructive Surgery

  https://www.med.unc.edu/surgery/plastic/forpatients/pediatric-plastic-and-craniofacial-surgery/cleft-lip-palate/

  Babies with clefts of the palate are more likely to develop fluid behind their eardrums (serous otitis media). […] Repair of a cleft lip typically occurs at around 3 months of age. […] The palate is typically repaired when the baby is between 9 and 12 months of age. […] Revision surgery refers to smaller procedures aimed at fine-tuning symmetry and balance of the nose and lip. […] For children who have clefts going through the gum line, bone must be placed in the gap in order to provide a stable platform for the canine tooth to erupt. […] For some children with clefts, the upper jaw does not grow properly.

• #92

  https://www.nhs.uk/conditions/cleft-lip-and-palate/treatment/

  Your child will have regular hearing tests to check for any issues. […] A paediatric dentist will monitor the health of your child’s teeth and recommend treatment when necessary. […] Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. […] Repairing 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 your child’s speech several times as they get older. […] 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.

• #93

  https://www.nhs.uk/conditions/cleft-lip-and-palate/treatment/

  Your child will have regular hearing tests to check for any issues. […] A paediatric dentist will monitor the health of your child’s teeth and recommend treatment when necessary. […] Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. […] Repairing 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 your child’s speech several times as they get older. […] 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.

• #94

  https://www.nhs.uk/conditions/cleft-lip-and-palate/treatment/

  Your child will have regular hearing tests to check for any issues. […] A paediatric dentist will monitor the health of your child’s teeth and recommend treatment when necessary. […] Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. […] Repairing 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 your child’s speech several times as they get older. […] 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.

• #95 Cleft lip and palate repair Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/surgery/cleft-lip-and-palate-repair

  Until the wound heals, your child will be on a liquid diet. Your child will probably have to wear arm cuffs or splints to prevent picking at the wound. It is important for your child not to put hands or toys in their mouth. […] Your child may still have problems with speech after the surgery. This is caused by muscle problems in the palate. Speech therapy will help your child.

• #96 Cleft Lip/Cleft Palate | Birth Defects | CDC

  https://www.cdc.gov/birth-defects/about/cleft-lip-cleft-palate.html

  Surgical repair can help restore function to the lips and mouth. It may help improve breathing, hearing, and speech and language development. Children born with orofacial clefts may also need special dental or orthodontic care or speech therapy. […] With treatment, most children with orofacial clefts do well and lead a healthy life. Some children may have issues with self-esteem if they are concerned with visible differences between themselves and other children.

• #97 Cleft Lip & Cleft Palate: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate

  Treatment may take many years and require several surgeries. But most children affected by these conditions have a normal childhood. Treatment helps improve speech and feeding issues. […] Its possible to breastfeed your baby if they have cleft lip and/or cleft palate. But youll need support from trained healthcare providers. […] Generally, children with clefts have the same dental needs as other children. However, children with cleft lip and palate may also have missing, misshapen or poorly positioned teeth. […] Problems with eating, hearing and speech are common in children with clefts. Children may also have issues with their teeth or self-esteem.

• #98

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut3193

  Watch your baby for problems with choking, gagging, or milk coming out through the nose while feeding. You may be able to use a small plastic plate that fits into the roof of the baby’s mouth while feeding. This blocks the opening so the baby can suck properly. […] Be alert for signs of dehydration. This can develop if your baby is not getting enough breast milk or formula. These signs include fewer wet diapers, sunken eyes with few tears, and a dry mouth with little or no spit. […] As your child grows, pay attention to dental care. Be sure to take your child to a dentist regularly starting within 6 months of when your child’s first tooth comes in but no later than age 1. A dentist will watch for dental problems and teach good dental habits. Check with your doctor about how to care for your baby’s mouth before the first dental visit. […] If you need more support, talk with your doctor or see a counsellor. Also, you may want to join a support group. It may help to talk with other parents who have babies with a cleft lip or cleft palate.

• #99 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Avoid feeding milk post-surgery. Be certain milk is not included in the first fluids offered because milk curds tend to adhere to the suture line and are difficult to remove. After a feeding, always offer the child a sip of clear water to rinse the suture line and keep it as clean as possible. […] Instruct the parents regarding oral care. Educate the parents to be diligent about oral health care. In infants with clefts involving the maxillary alveolar ridge (upper gum), it is common for some teeth to be misshapen or turned. Prudent twice-daily gum and teeth brushing with an age-appropriate toothbrush and toothpaste are crucial, as are bi-yearly dental visits for monitoring. […] Reducing Anxiety and Enhancing Coping […] A mother’s first reaction to a disfigured newborn is one of shock, hurt, disappointment, and guilt. Some parents may regard the deformity as a result of their inadequacies. They may desire to hide the child from relatives and friends. The client and the family need understanding, a concrete basis for hope, and practical advice. Family stress often occurs because of the multiple surgeries that may be required throughout childhood.

• #100 Cleft Palate & Cleft Lip | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/cleft-lip-cleft-palate/

  A cleft lip is usually repaired surgically when the baby is between three to six months old. […] Caregivers can expect that baby will recover well after cleft lip repair. […] A cleft palate is usually repaired between 10 and 12 months of age. […] The goal of surgery is to create a palate that works well for feeding and speech. Most children will have good speech after palate repair. […] Routine post-operation care will be with a plastic surgeon on a frequent basis. […] Long-term effects of a cleft lip are often unnoticed until school age, as this is when patients themselves start to notice that their lip and nose may look a little different than their peers. […] Long term effects of a cleft palate are related to speech and feeding. […] Lurie Childrens offers the services of an entire cleft lip and palate team, which consists of expert physicians and staff in the following specialties: ear, nose and throat; audiology; dentistry; orthodontics; plastic surgery; speech therapy; psychology and social work. […] Lurie Childrens recommend that all children with cleft lip and/or palate should be followed by a team certified by the American Cleft Palate-Craniofacial Association (ACPA).

• #101

  https://www.nhs.uk/conditions/cleft-lip-and-palate/treatment/

  Your child will have regular hearing tests to check for any issues. […] A paediatric dentist will monitor the health of your child’s teeth and recommend treatment when necessary. […] Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. […] Repairing 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 your child’s speech several times as they get older. […] 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.

• #102

  https://www.nhs.uk/conditions/cleft-lip-and-palate/treatment/

  Most babies are in hospital for 1 to 2 days. […] 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. […] Palate repair surgery is usually done when your baby is 6 to 12 months old. […] 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. […] A specialist cleft nurse can advise on positioning, alternative feeding methods and weaning if necessary. […] Children with a cleft palate are more likely to develop a condition called glue ear, where fluid builds up in the ear and may reduce hearing.

• #103

  https://www.nhs.uk/conditions/cleft-lip-and-palate/treatment/

  Your child will have regular hearing tests to check for any issues. […] A paediatric dentist will monitor the health of your child’s teeth and recommend treatment when necessary. […] Orthodontic treatment, which helps improve the alignment and appearance of teeth, may also be required. […] Repairing 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 your child’s speech several times as they get older. […] 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.

• #104 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Assess suture lines for cleanliness, redness, swelling, or drainage frequency. This provides information indicating possible infection and the need for cleansing away formula or drainage. The incision line should appear clean and intact and free of erythema or drainage during the postoperative period. […] Assess for respiratory distress following palate surgery. This monitors breathing through a smaller airway caused by edema and breathing through the nose. Because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe the infant closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess for signs of infection such as fever, pain, pulling on an ear, or discharge from the ear. Review the signs of infection such as fever, pain, pulling on an ear, or discharge with the parents. Fever can be as high as 40C (104F). Infants’ earaches may manifest by general irritability, frequent rubbing or pulling at the ear and rolling of the head from side to side.

• #105 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Encourage the intake of liquids and soft foods, as indicated. Movement of the eustachian tube, such as chewing, may increase the pain. Liquids and a soft diet may reduce pain as they do not involve vigorous chewing. The child may name some foods and fluids they are willing to eat; they may eat less than usual but ensure that they take an adequate amount. […] Clean the skin around the ears thoroughly. The child may experience ear drainage, which they may not notice at times. The skin around the client’s ears must be clean and protected from drainage to prevent tissue breakdown. […] Educate the parents regarding treatment using myringotomy tubes. Because the eustachian tube may remain partially closed in its changed position, serous otitis media (accumulation of fluid in the middle ear) also tends to occur more frequently in these children than in others. If this happens, myringotomy tubes may be inserted to drain the middle ear fluid and to help protect hearing.

• #106 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Educate the parents regarding signs and symptoms of complications that are needed to be reported immediately. Remind the parents of the importance of recognizing and reporting signs of pharyngeal infection to their primary care provider promptly so it can be treated before the infection spreads to the middle ear. […] Apply a warm or cold compress to decrease pain and promote comfort. A warm compress may be applied locally to increase the child’s comfort. Cold may also be beneficial. An ice pack may be prescribed to reduce edema and pressure. […] Instruct the parents never to insert anything into the child’s ear. Parents are instructed not to insert cotton swabs or any object into the child’s ears, especially when cleaning. These objects may rupture the tympanic membrane, further complicating the child’s ear infection.

• #107 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Psychological and Social Well-being. Individuals with cleft lip and cleft palate may face challenges related to self-esteem, body image, and social interactions due to visible facial differences. Providing psychological support and addressing any emotional difficulties can contribute to their overall well-being. […] Facial Aesthetics and Plastic Surgery. Reconstructive surgery plays a vital role in correcting the cleft lip and palate, improving facial aesthetics, and restoring normal function. Surgical interventions are typically staged and performed by experienced plastic surgeons. […] Nursing Assessment […] Assess for the following subjective and objective data: […] See nursing assessment cues under Nursing Interventions and Actions. […] Nursing Diagnosis […] Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with cleft lip and cleft palate based on the nurse’s clinical judgment and understanding of the patient’s unique health condition.

• #108 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Psychological and Social Well-being. Individuals with cleft lip and cleft palate may face challenges related to self-esteem, body image, and social interactions due to visible facial differences. Providing psychological support and addressing any emotional difficulties can contribute to their overall well-being. […] Facial Aesthetics and Plastic Surgery. Reconstructive surgery plays a vital role in correcting the cleft lip and palate, improving facial aesthetics, and restoring normal function. Surgical interventions are typically staged and performed by experienced plastic surgeons. […] Nursing Assessment […] Assess for the following subjective and objective data: […] See nursing assessment cues under Nursing Interventions and Actions. […] Nursing Diagnosis […] Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with cleft lip and cleft palate based on the nurse’s clinical judgment and understanding of the patient’s unique health condition.

• #109 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach the family that overprotective behavior may hinder growth and development and treat the child as normally as possible. This enhances family understanding of the importance of making a child one of the family and the adverse effects of overprotection of the child. Reinforce the child’s positive attributes, stressing that a scar is only one small aspect of who they are. […] Refer the family and the child to community support groups as appropriate. Many communities have support groups for parents of children born with a cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation provides parent education materials on its website. […] Assist in the referral of the parents to genetic counseling. Because of the genetic influence, the parents of a child diagnosed with a cleft lip should be referred for genetic counseling to ensure they understand they have a small increased chance of having another child with a cleft lip or palate and that any future children are at a greater risk than usual for this problem.

• #110 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach the family that overprotective behavior may hinder growth and development and treat the child as normally as possible. This enhances family understanding of the importance of making a child one of the family and the adverse effects of overprotection of the child. Reinforce the child’s positive attributes, stressing that a scar is only one small aspect of who they are. […] Refer the family and the child to community support groups as appropriate. Many communities have support groups for parents of children born with a cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation provides parent education materials on its website. […] Assist in the referral of the parents to genetic counseling. Because of the genetic influence, the parents of a child diagnosed with a cleft lip should be referred for genetic counseling to ensure they understand they have a small increased chance of having another child with a cleft lip or palate and that any future children are at a greater risk than usual for this problem.

• #111 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach the family that overprotective behavior may hinder growth and development and treat the child as normally as possible. This enhances family understanding of the importance of making a child one of the family and the adverse effects of overprotection of the child. Reinforce the child’s positive attributes, stressing that a scar is only one small aspect of who they are. […] Refer the family and the child to community support groups as appropriate. Many communities have support groups for parents of children born with a cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation provides parent education materials on its website. […] Assist in the referral of the parents to genetic counseling. Because of the genetic influence, the parents of a child diagnosed with a cleft lip should be referred for genetic counseling to ensure they understand they have a small increased chance of having another child with a cleft lip or palate and that any future children are at a greater risk than usual for this problem.

• #112 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Teach the family that overprotective behavior may hinder growth and development and treat the child as normally as possible. This enhances family understanding of the importance of making a child one of the family and the adverse effects of overprotection of the child. Reinforce the child’s positive attributes, stressing that a scar is only one small aspect of who they are. […] Refer the family and the child to community support groups as appropriate. Many communities have support groups for parents of children born with a cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation provides parent education materials on its website. […] Assist in the referral of the parents to genetic counseling. Because of the genetic influence, the parents of a child diagnosed with a cleft lip should be referred for genetic counseling to ensure they understand they have a small increased chance of having another child with a cleft lip or palate and that any future children are at a greater risk than usual for this problem.

• #113 Cleft Lip and Cleft Palate Nursing Care Management

  https://nurseslabs.com/cleft-lip-cleft-palate/

  Cleft lip and cleft palate can be emotionally challenging for affected individuals and their families, necessitating comprehensive and multidisciplinary care from healthcare professionals. […] A complete and thorough process of care should be undergone by the newborn with cleft lip and cleft palate. […] One primary concern in the nursing care of a newborn with a cleft lip and cleft palate is the emotional care of the newborn’s family. […] Based on the assessment data, the major nursing diagnoses are: Compromised family coping related to visible physical defect. […] Goal setting and planning must be modified to adapt to the surgical plans; the major goals include: Maintaining adequate nutrition. […] Nursing interventions for the patient with cleft lip and palate are: Maintain adequate nutrition.

• #114 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Nursing Goals […] Goals and expected outcomes may include: […] The infant will maintain a clear airway as evidenced by clear breath sounds and the absence of cyanosis. […] The infant will display a respiratory rate of 20 to 30 breaths per minute, absence of retractions, and respiratory distress. […] The neonate will exhibit adequate nutritional status to maintain growth and healing. […] The family will report decreased anxiety levels concerning the infant’s condition. […] The family will demonstrate problem-solving skills and the use of resources effectively. […] The family will increase coping ability concerning the infant’s condition and care needs. […] The parents will verbalize that they believe there will be a positive outcome for the infant. […] The parents will demonstrate coping behaviors evidenced by holding and helping with infant care.

• #115 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Maintaining Airway Clearance and Preventing Aspiration […] Infants diagnosed with a cleft palate cannot suck effectively either because pressing their tongue or a nipple against the roof of their mouth forces milk into their pharynx, possibly leading to aspiration. Additionally, because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe children closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty. […] Assess the newborn’s respiratory rate, depth, and effort. Aspiration of secretions or milk may cause tachypnea. Newborns are obligate nose breathers and show signs of distress if their nostrils become obstructed. The newborn’s respiratory rate can be observed most easily by watching the newborn’s abdomen because breathing primarily involves using the diaphragm and abdominal muscles.

• #116 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Inform parents of usual ages for cleft lip repair and/or cleft palate, stages of surgery, and type of procedure performed. This provides information to reduce fear and anxiety and to know what to expect. If a cleft lip is discovered while the infant is still in utero, fetal surgery can repair the condition, although this procedure is not usually attempted. If the disorder is discovered at birth, a cleft lip can be repaired surgically shortly thereafter, often at the time of the initial hospital stay or between 2 and 12 weeks of age. […] Refer the parents to additional resources for necessary counseling and support. Referrals to community support groups may be useful from time to time to assist the parents in dealing with anxiety. Many communities have support groups for parents of children born with cleft lip or palate. Referral to these groups can offer the parents additional support. The National Cleft Palate Foundation is one such support group.

• #117 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Monitor lip protective device taped on operative site. This relaxes the site and prevents tension on sutures caused by facial movement or crying. After cleft lip surgery, the suture line may be held in close approximation by a Logan bar (a wire bow taped to both cheeks) or an adhesive bandage such as a Band-aid simulating a bar that brings together the incision line but does not cover the incision. Assess that this is secure and continues to protect the suture line from tension after each feeding or cleaning of the suture line. […] Perform strict care of the suture line. Infection and subsequent scarring may result if crusts from serous drainage are allowed to form on a cleft lip suture line. Most surgeons prescribe cleaning the suture line with sterile water or sterile saline with sterile cotton-tipped applicators after every feeding or whenever the normal serum that forms on suture lines accumulates.

• #118 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Determine the parents’ current knowledge and perception of the situation. The lack of information or unrealistic expectations can interfere with family members and the client’s response to the defect and the situation. […] Encourage expressing concerns and questions about the condition to discuss feelings about the infant’s appearance. This provides an environment conducive to venting feelings to facilitate the adjustment to the infant’s defect. It also provides an opportunity to examine realistic fears and misconceptions about the condition. […] Provide an accepting environment and attitude and handle the infant in a gentle, caring way. This promotes trust and conveys to parents that an infant is a valuable human baby deserving of love and caring. Provide an open environment wherein the parents, and the child feel accepted in their present condition without feeling judged and can promote a sense of dignity and control.

• #119 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Provide instructions when complications are identified at home. Ear infections and dental decay may accompany cleft palate. Parents are instructed to take the child to the health care provider at the first sign of earache. […] Initiating Patient Education and Health Teachings […] Mothers of infants diagnosed with cleft lip and palate may have limited knowledge about feeding their infants and may lack information regarding regurgitation, colic, and swallowing during feedings. Mothers may feel stressed or confused when various healthcare professionals provide conflicting feeding suggestions. Feeding instructions help parents develop confidence in properly caring for their infant diagnosed with cleft lip and palate. […] Assess the presence of acceptance of methods used by parents and their knowledge of the cause and type of defects. This provides information about a defect that may be inherited or congenital, partial or complete, unilateral or bilateral cleft of the lip and/or palate, adequate nutritional status, and freedom from infection before surgery is done.

• #120 5 Cleft Lip and Cleft Palate Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/cleft-lip-cleft-palate-nursing-care-plans/

  Explain to parents that usual feeding patterns may be resumed in 2 weeks for lip repair or in 4 to 6 weeks for palate repair. This provides an estimated time based on suture removal and healing to resume regular bottle feeding or return to baseline dietary status. The infant receives feedings by dropper until the wound is completely healed (1 to 2 weeks). Care should be taken to avoid touching the suture line when inserting the medicine dropper. […] Refer parents and the child to appropriate professional resources after discharge. Children diagnosed with cleft problems tend to receive better, more frequent, and well-coordinated care when seen in an interprofessional team setting, including pediatric dentists, audiologists, speech pathologists, geneticists, and craniofacial surgeons, so referring parents to an appropriate interprofessional center before discharge is critical for these infants and their families.

• #121 Cleft Lip and Palate Center | Spokane, WA | Providence

  https://www.providence.org/locations/wa/spokane-cleft-lip-and-palate-center

  We remain your childs provider throughout their teen years, transitioning care around age 19. Our team continuously checks your childs progress in a range of health areas, including: […] As your child grows and develops, the nurse coordinator will adjust the care plan to meet their changing needs. […] Our nurse coordinators educate the community about the needs of children with cleft lip, cleft palate and other facial birth defects. We consult with doctors, hospital staff and community providers to ensure children receive the best possible care.

• #122 Cleft Palate & Cleft Lip | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/cleft-lip-cleft-palate/

  Cleft lip is formed in the upper lip as either a small gap or dent in the lip and can continue into the nose. […] Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined. […] The results of treatment for cleft lip and palate are usually excellent both aesthetically and functionally. Children born with these conditions have a good quality of life and a normal life expectancy. […] When a fetus is diagnosed with cleft lip and/or palate, the hospital’s surgeons and nurses counsel parents about what to expect when their baby is born and reassure them that it is correctable after birth. […] Parents are given special bottles designed to easily feed their baby and instructed on how to use them, so they are prepared when the baby is born.

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