Cleft palate

What is a cleft palate?

A cleft palate is a hole in the palate (roof of the mouth) that did not come together in the early months of fetal development.

Surgery is needed to repair the cleft, usually around one year of age.

How can my baby eat?

Your baby's feeding plan is determined by the severity of the cleft palate and if a cleft lip is also present. Feeding options may include breastfeeding with some modifications (see the education sheet "Breastfeeding an infant with cleft lip"), bottle-feeding with special bottles or nipples, or using a feeding tube. The doctor and nurses will teach you how to use the feeding aid that will best meet the needs of your child.

Several weeks before surgery your doctor will tell you if you need to wean your child from the bottle and pacifier. This is done to decrease the frustration your child might have after surgery, when sucking on a nipple is not allowed. Many surgeons do not do the palate surgery until the child is weaned off of the bottle and pacifier. Feeding methods include cup, sippy cup, syringe, and spoon feeding.

What can I expect after surgery?

The anesthesiologist and surgeon will prescribe and explain the medicine that will be used to keep your child comfortable. Your child will have an intravenous line (IV) to provide fluids, pain medicines, and antibiotics.

A monitor will be used to observe your child's heart rate and breathing patterns while receiving IV pain medicines.

As your child is waking from surgery drooling may be present. It may be red or pink-tinged with some blood. This is normal and will stop. Raising the head of the bed or side-lying will help. Nose drainage may also be red, pink-tinged, or brown-tinged. Sometimes the secretions may be suctioned with a small, soft tube.

Your child will not have anything to drink until fully awake from anesthesia. This is usually 4 to 6 hours after surgery, depending on the doctor's orders.

At first, your child will be given clear liquids (such as sugar water and apple juice by a method determined by the doctor (spoon, small cup, or syringe attached to a small rubber tube). Each feeding is followed by a water rinse to keep the incision clean of any sugar or food particles.

The doctor will decide when the palate incision is healed enough to add milk products and then pureed foods. See the education sheet, "Cleft palate repair: Feeding your child". Again, all feedings should be followed by a water rinse. No nipples, pacifiers, or straws are permitted. Your doctor will decide if a cup with a small lip can be used.

Children often will cry and resist the feedings. However, crying will help swish the fluids against the palate incision to keep
it clean. Many children do not start drinking well until 24 to 48 hours after the operation.

A pain reliever such as acetaminophen (Tylenol® or another brand) will be given for discomfort about every 4 to 6 hours. This is often a frustrating time for you and your child and extra comfort and holding during this time may be helpful.

During the first few days after surgery you may notice drainage from the nose that is similar to the feedings. This is normal.

How can I care for my child?

Your child will need to wear arm cuffs at all times to keep fingers and toys out of the mouth. Use a long-sleeved shirt under the arm cuffs to protect the skin. The arm cuffs can be taped to the pajama top so they don't slide off. Do not tape them to your child's skin. Use the arm cuffs for as long as prescribed by the surgeon.

Take off the arm cuffs, one arm at a time, to exercise arms and hands 2 or 3 times a day. Check for red or tender areas in the armpit
or wrist area.

Avoid giving your child any hard toys or toys with sharp edges.

See your Discharge Instruction Sheet for specific instructions about when to see the surgeon again.

Speech therapy can begin about 6 weeks after surgery.

When should I call the surgeon?

any unusual drainage or bleeding from the mouth
temperature higher than 100.5° F (38° C) under the arm
unable to drink liquids

What else do I need to know?

Financial aid may be available through Services for Children with Handicaps or TEFRA. For more information, contact the hospital social worker, or your local county social worker. Other resources include:

Cleft Palate Foundation
1829 E. Franklin St. Suite 1022
Chapel Hill, NC 27514
1-800-24-CLEFT
www.cleftline.org

Cleft and Craniofacial Clinic
Children's Hospitals and Clinics
2525 Chicago Avenue South
Minneapolis, MN 55404
612-813-6888

Questions?

This sheet is not specific to your child but provides general information. If you have any questions, please call the doctor.

This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit www.childrensmn.org/educationmaterials.