MY STUDENT SUPPORT SYSTEM: CLEFT LIP AND CLEFT PALATE- ENGLISH

CLEFT LIP AND CLEFT PALATE

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CLEFT LIP AND CLEFT PALATE-

Cleft lip and cleft palate are among the most common birth defects or congenial anomalies. Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one (unilateral cleft lip) or both sides (bilateral cleft lip) of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.

Sign and symptoms-

· A split in the lip and roof of the mouth (palate) that may affects expression of one or both sides of the face

· A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose

· A split in the roof of the mouth that doesn't affect the appearance of the face

· Difficulty with feedings

· Difficulty swallowing, with potential for liquids or foods to come out the nose

· Nasal speaking voice

· Chronic ear infections

Diagnostic Investigations-

Observation and physical examination just after delivery of later after appearance of sign and symptoms.

It can be diagnosed by ultrasound before birth ( intrauterine diagnosis )

Management-

Services and treatment for children with cleft lip and cleft palate can vary depending on the severity of the cleft; the child’s age and needs; and the presence of associated syndromes or other birth defects.

Surgical repair a cleft lip usually occurs in the first few months of life and is recommended within the first 12 months of life. Surgical repair a cleft palate is recommended within the first 18 months of life or earlier if possible.

Surgical repair can improve the look and appearance of a child’s face and might also improve breathing, hearing, and speech and language development.

With treatment, most children with cleft lip and cleft palate do well and lead a healthy life. Some children with cleft lip and cleft palate may have issues with self-esteem if they are concerned with visible differences between themselves and other children.

Nursing Management-

Goal setting and planning must be modified to adapt to the surgical plans; the major goals 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.

Nursing Intervetions Includes-

Maintaintenance of adequate nutrition. Breastfeeding should be encouraged to maintain adequate nutrition.; if the newborn cannot be breastfeed, the mother’s breast milk may be expressed and used instead of formula.
Positioning. If the cleft lip is unilateral, the nipple should be aimed at the unaffected side; the infant should be kept in an upright position during feeding.
Tools for feeding. Lamb’s nipples (extra long nipples) and special cleft palate nipples molded to fit into the open palate area to close the gap may be used; one of the simplest and most effective methods may be the use of an eyedropper or an Asepto syringe with a short piece of rubber tubing on the tip (Breck feeder).
Promote family coping. Encourage the family to verbalize their feelings regarding the defect and their disappointment, provide psychological support to parents and explain positive aspects of correction of the defects and other possible treatment.
Reduce family anxiety. Give the family information about cleft repairs; encourage them to ask questions and reassure them that any question is valid.
Provide family teaching. Explain the usual routine of preoperative, intraoperative, and post operative care; written information is helpful, but be certain the parents understand the information.
Other Nursing interventions – includes all nursing care of hospitalized child that we have discussed in previous lecture .