How to Care For Your Child After Cleft Lip Repair

Feeding Your Child and Protecting Their Surgical Site

Baby girl with a cleft lip
Baby girl with a cleft lip. Peopleimages/Getty Images

Proper management of your child’s cleft lip repair is very important to prevent damage to the surgical site. Any complications can lead to additional scarring, a longer healing period, and even increase the possibility that your child will need extra surgeries. This article will explain how to best care for your child after their cleft lip repair, but because all cases are unique, please follow your doctor's instructions if they differ from this document.

Feeding Your Child After Cleft Lip Repair

After your child’s surgery, they will remain in the hospital until they are able to be supported nutritionally, their pain is well-controlled, and they are finished with necessary intravenous medications or able to take these medications by mouth. Feeding after this surgery can be one of the biggest obstacles you need to overcome in order to take your child home.

You may find that there is a lot of controversy over whether you should breast-feed, bottle-feed, or spoon-feed your child during the time period immediately following surgery (post-op period). The method that you choose will depend on your child's individual circumstances as well as your own personal preferences and your family's needs. Your medical team, including your surgeon and speech-language pathologist, can help you to choose the best feeding technique for your situation. These professionals can also assist you in getting the proper supplies you may need; for example, if you choose to bottle-feed your child, you need to use an approved nipple with the bottle.

Regardless of the method you choose to feed your child, protection of the incision (wound) area is necessary for your child to heal. It is discouraged to have anything hard in your child’s mouth until after the surgical incisions have healed. If you are spoon-feeding, you need to ensure that you are using the side of the spoon for feeding.

Do not use forks or other utensils, as they can damage the incision. After each feeding, many health care professionals recommend your child drink about 5-15 milliliters of water. Using water will "cleanse" the area and help to remove food that could potentially lead to an infection.

Protecting Your Child’s Surgical Site After Cleft Lip Repair

After surgery, you may find that your surgeon has used something like the Logan’s Bow (metal bar) or Steri-Strips to help protect the incision. This will remain in place until your surgeon clears the removal of the bar at a follow-up appointment after your child has been discharged from the hospital (generally about 1 week after your child’s discharge date). When you are holding your child, cradling them is preferred to keep them from bumping their lip and nose into your shoulder until they have fully healed. When they are lying down, be sure to keep them off their stomach as well by keeping them in either a side or back-lying position. Pacifiers should also not be used as they will cause extra tension on the surgical site.

After surgery, your child will have soft arm or elbow restraints on to help prevent them from rubbing or messing with their incision. Generally, the restraints will need to be used for approximately 2 to 3 weeks. During this time, it is important for them to wear the restraints as much as possible. While you are supervising them, it is okay to remove the restraints several times a day; however, you will want to make sure to avoid having them rub their lip and nose or suck on their thumb.

When removing the restraints, it is generally recommended that you only remove one restraint at a time. Take this time to move the arms all around to prevent loss of mobility and check to make sure that there are no reddened areas on the arms where the restraints had been.

Preventing Infection After Cleft Lip Repair

Infection is a potential complication of any surgery. Depending on your doctor's preference, he or she may prescribe a course of antibiotics to prevent infection after the procedure, or your child may receive a one-time IV dose of antibiotics during their surgery. If your doctor has prescribed antibiotics to be taken after the cleft lip repair, make sure you give the medication to your child on time, as directed, and until the bottle is completely gone.

Keeping your child’s incision and sutures clean is very important in preventing infection. Some surgeons will have you clean the incision regularly, while others may prefer that you leave the incision clean and dry and do not touch it. Many doctors recommend cleaning with normal saline or mild soap and water. Some surgeons recommend cleaning the incision with half-strength hydrogen peroxide, especially if there is a lot of crust formation around the incision and sutures. If you use half-strength hydrogen peroxide, be sure to clean with plain water or saline afterward, as hydrogen peroxide can kill healthy cells as well as germs and be irritating to your child’s skin if not rinsed off.

If your doctor wants you to clean the incision, you will receive specific instructions that you should follow closely. A common recommendation is to apply the cleaning solution with a cotton swab in a circular motion without applying pressure directly on the incision.

Your surgeon may also recommend an antibiotic ointment, such as bacitracin or Neosporin, which you apply to your child’s incision after you have cleaned the skin and allowed sufficient time for the site to dry. This is used to help protect the incision from nasal drainage by creating a barrier between the drainage and the skin, as well as inhibit the growth of germs.

This is especially important since the incision for a cleft-lip repair is so close to the nose and mouth, which is a particularly dirty area. Antibiotic ointment can also be useful because it prevents the formation of a scab-like crust at the incision, which can sometimes be painful. Typically, your surgeon will recommend you apply the ointment about three times a day for two days, but again, each case is different.

Managing Pain After Cleft Lip Repair

Your child will have some pain after their cleft lip repair, which will be controlled using pain medications. Right after surgery, this will probably be a narcotic pain medication that is given through your child's IV. As your child recovers, they will require less and less pain medicine. By the time your child is discharged from the hospital, their pain should be fairly well-controlled. Your surgeon may send you home with some prescription-strength medications or make over-the-counter medication recommendations, like acetaminophen (Tylenol).

You should not use ibuprofen (Advil) without the permission of your doctor and aspirin is not recommended for children as it can cause Reye's syndrome.

You should not worry about your child becoming addicted to narcotic pain medication. Controlling pain will help your child to heal faster because they will get more restful sleep. Pain can also raise a person's heart rate and blood pressure and can cause the release of a hormone called cortisol, which can actually inhibit the immune system.

You should also be aware that unrelieved pain can be a sign that there is a surgical complication that needs to be treated. Don't be surprised if acetaminophen is all your child needs to control their pain -- many children require very little narcotic pain medication. However, every child is different and the most important thing is that your child is comfortable after their cleft lip repair.

Aside from medications, if your child is fussy, comforting measures like holding and rocking, talking softly to them, and basically anything that you can do to show affection and to comfort your child may prove useful. Distraction with a favorite TV show or music can also be helpful. If your child is having unrelieved pain despite your best efforts, you should call your doctor. Also, if you feel that your child is not doing well, call your doctor. You know your child best and as the parent, you will be the first person to notice a problem. You should not worry about "bothering" the doctor. It is always best to bring any concerns to your doctor's attention as soon as possible.

As a nurse, one of the things that I enjoy most about working with children is that they are so resilient. It is so difficult as parents to see our children suffer, but most parents are pleasantly surprised to find that their child is much tougher than they anticipated. As long as you follow your doctor's instructions, you can avoid surgical complications and your little one should be feeling better before you know it.

Sources:

Intermountain Healthcare. (2009). Let’s Talk About… Cleft Lip and Palate. Accessed: May 29, 2012 from https://intermountainhealthcare.org/ext/Dcmnt?ncid=520408176

Medline Plus. (2012). Cleft lip and palate repair – discharge. Accessed: May 29, 2012 from http://www.nlm.nih.gov.ezproxy.lib.utah.edu/medlineplus/ency/ patientinstructions/000004.htm

Nagy, K. & Mommaerts, M.Y. (2011). Postoperative Wound Management After Cleft Lip Surgery. Cleft Palate-Craniofacial Journal. Vol. 48 No. 5.

Pearson Higher Education. (n.d.) Nursing Care Plan: The Infant with a Cleft Lip and/ or Palate. Accessed: May 29, 2012 from http://wps.prenhall.com/wps/media/ objects/354/362846/Child%20-%20Cleft%20Palate.pdf

University of Michigan Health Systems – Department of Surgery. (2012). Cleft Lip Repair (Cheiloplasty) Post-Operative. Accessed: May 29, 2012 from http://surgery.med.umich.edu/plastic/patient/ped_procedures/cleftlp/ cheilo_postop.shtml

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