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Cleft Lip and Palate

Prepared by:
John Paul Hocon
Disease Description
 Cleft lip (cheiloschisis) is a congenital anomaly
that occurs at a rate of 1 in 800 births.
 If the cleft does not affect the palate structure of the
mouth it is referred to as cleft lip.
 Cleft lip is formed in the top of the lip as either a small
gap or an indentation in the lip (partial or incomplete
cleft) or it continues into the nose (complete cleft)
 Cleft lip can be unilateral or bilateral.
 It is due to the failure of fusion of the maxillary and
medial nasal processes (formation of the primary
 Cleft palate (palatoschisis) is a congenital
anomaly that occurs in approximately 1 of every
2000 births, and it is more common in boys than
 It is a condition in which the two plates of the skull that
form the hard palate (roof of the mouth) are not
completely joined.
 It ranges in severity from soft palate involvement
alone to a defect including the hard palate and
portions of the maxilla.
 Cleft palate may or may not be associated with cleft
 Children with these structural disorders may
have associated dental malformations,
speech problems, and frequent otitis media,
the latter resulting from improper functioning
of the Eustachian tubes.
 Many factors are associated with the
development of cleft lip and cleft palate, and
cleft lip with or without cleft palate is
developmentally and genetically different from
isolated cleft palate.
 Most cases appear to be consistent with the
concept of multifactorial inheritance as evidenced
by an increase incidence in relatives and
monozygotic twins.
 During embryonic development the lateral and
medial tissues forming the upper lip palates fuse
between weeks 7 and 8 of gestation; the palatal
tissues forming the hard and soft palates fuse
between weeks 7 and 12 gestation.
 Cleft lip and cleft palate result when these
tissues fail to fuse.
Assessment findings
 Clinical manifestations
 Cleft lip and cleft palate are readily apparent at birth.
Careful physical assessment should be performed to
rule out other midline birth defects.
 Cleft lip and cleft palate appear as incomplete or
complete defects, and may be unilateral or bilateral.
 Laboratory and diagnostic study findings.
Obstetric ultrasound will reveal cleft lip while the
infant is in utero.
Nursing Management
 Assess for problems with feeding, breathing parental
bonding, and speech.
 Ensure adequate nutrition and prevent aspiration.
 Provide special nipples or feeding devices (eg, soft pliable
bottle with soft nipple with enlarged opening) for a child
unable to suck adequately on standard nipples.
 Hold the child in a semiupright position; direct the formula
away from the cleft and toward the side and back of the
mouth to prevent aspiration.
 Feed the infant slowly and burp frequently to prevent
excessive swallowing of air and regurgitation.
 Stimulate sucking by gently rubbing the nipple against the
lower lip.
 Support the infant’s and parents’ emotional
and social adjustment.
 Help facilitate the family’s acceptance of the infant by
encouraging the parents to express their feelings and
concerns and by conveying an attitude of acceptance
toward the infant.
 Emphasize the infant’s positive aspects and express
optimism regarding surgical correction.
Pre-operative care
 Depending in the defect and the child’s general condition,
surgical correction of the cleft lip usually occurs at 1 to 3
months of age; repair of the cleft palate is usually performed
between 6 and 18 months of age. Repair of the cleft palate
may require several stages of surgery as the child grows.
 Early correction of cleft lip enables more normal sucking
patterns and facilitates bonding. Early correction of cleft
palate enables development of more normal speech
 Delayed closure or large defects may require the use of
orthodontic appliances.
 The responsibilities of the nurse are to:
 Reinforce the physician’s explanation of surgical procedures.
 Provide mouth care to prevent infection.
Post-operative Care
 Assess airway patency and vital signs; observe for edema
and respiratory distress.
 Use a mist tent, if prescribed, to minimize edema, liquefy
secretions, and minimize distress.
 Position the child with cleft lip on her back, in an infant
seat, or propped on a side to avoid injury to the operative
site; position the child with a cleft palate on the abdomen to
facilities drainage.
 Clean the suture line and apply an antibacterial ointment as
prescribed to prevent infection and scarring. Monitor the site
for signs of infection.
 Use elbow restraints to maintain suture line integrity.
Remove them every 2 hours for skin care and range-
of-motion exercises.
 Feed the infant with a rubber-tipped medicine dropper,
bulb syringe, Breck feeder, or soft bottle-nipples, as
prescribed, to help preserve suture integrity. For older
children, diet progresses from clear fluids; they should
not use straws or sharp objects.
 Attempt to keep the child from putting tongue up to
palate sutures.
 Manage pain by administering analgesic as
Nursing Care Plan

“I noticed that my son cannot suck my nipples
properly during breastfeeding”

 Difficult in feeding

 Malformation of lips and roof of the mouth

Risk for Aspiration(Breast Milk, formula or
mucus) as related to anatomic effect.
After 30 minutes of nursing intervention,
position the infant in a proper position like
football hold to maintain proper breathing
pattern to prevent from aspiration or choking.
Expected Outcome
 Airway Maintenance:
Toleration of enteral feedings without
 The infant exhibits no signs of respiratory
Aspiration Precautions:
 Prevention or minimization of risk factors in
the patient at risk of aspiration.
 if theres a case an infant has an episode of
choking or aspiration position the infant in a
football hold to maintain proper breathing.
 to
prevent from possible of episode of
choking or aspiration
After 30 minutes of nursing intervention the
infant can breath properly after he/she was
positioned in a football hold to maintain
proper breathing pattern