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When Your Child was in the Hospital

Your child had surgery to repair birth defects that caused a cleft in which the lip or the roof of the mouth did not grow together normally while your child was in the womb. Your child had general anesthesia (asleep and not feeling pain) for the surgery.

What to Expect at Home

After anesthesia, it is normal for children to have stuffy noses. They may need to breathe through their mouths for the first week. There will be some drainage from their mouths and noses. The drainage should go away after about 1 week.

Incision Care

Clean the incision (surgery wound) after feeding your child.

• Your surgeon may give you a special liquid (hydrogen peroxide) for cleaning the wound. Use a cotton swab (Q-tip) to do so. If not, clean with warm water and soap.
• Wash your hands before starting.
• Begin at the end that is closer to the nose.
• Always begin cleaning away from the incision in small circles. Do not rub right on the wound.
• If your surgeon gave you an antibiotic ointment, put it on your child's incision after it is clean and dry.

Some stitches will break apart or go away on their own. The surgeon will need to take others out at the first follow-up visit. Do not remove your child's stitches yourself unless instructed by your surgeon.

You will need to protect your child's incision.

• Feed your child only the way your surgeon told you.
• Do not give your child a pacifier.
• Babies will need to sleep in an infant seat, on their backs.
• Do not hold your child with their face toward your shoulder. They can bump their nose and harm their incision.
• Keep all hard toys away from your child.
• Use clothes that do not need to be pulled over the child's head or face.

Feeding

Young infants should be eating only breast milk or formula. When feeding, hold your infant in an upright position.

Use a cup or the side of a spoon for giving your child drinks. If you use a bottle, use only the kind of bottle and nipple that your surgeon has recommended.

Older infants or young children will need to have their food softened or pureed for some time after surgery so it is easy to swallow. Use a blender or food processor to prepare food for your child.

Children who are eating foods other than breast milk or formula should be sitting when they eat. Feed them only with a spoon. Do not use forks, straws, chopsticks, or other utensils that can harm their incisions.

There are many good food choices for your child after surgery. Always make sure the food is cooked until it is soft, then pureed. Good food options include:

• Cooked meats, fish, or chicken. Blend with broth, water, or milk.
• Mashed tofu or mashed potatoes. Make sure they are smooth and thinner than normal.
• Yogurt, pudding, or gelatin.
• Small curd cottage cheese.
• Formula or milk.
• Creamy soups.
• Cooked cereals and baby foods.

Foods your child should not eat include:

• Seeds, nuts, bits of candy, chocolate chips, or granola (not plain, nor mixed into other foods)
• Gum, jelly beans, hard candy, or suckers
• Chunks of meat, fish, chicken, sausage, hot dogs, hard cooked eggs, fried vegetables, lettuce, fresh fruit, or solid pieces of canned fruit or vegetables
• Peanut butter (not creamy or chunky)
• Toasted bread, bagels, pastries, dry cereal, popcorn, pretzels, crackers, potato chips, cookies, or any other crunchy foods

Activity

Your child may play quietly. Avoid running and jumping until the surgeon says it is OK.

Your child may go home with arm cuffs or splints. These will keep your baby from rubbing or scratching the incision. Your child will need to wear the cuffs most of the time for about 2 weeks. Put on the cuffs over a long-sleeve shirt. Tape them to the shirt to keep them in place if needed.

• You may take the cuffs off 2 or 3 times a day. Take off only 1 at a time.
• Move your child's arms and hands around, always holding on and keeping them from touching the incision.
• Make sure there is no red skin or sores on your child's arms where the cuffs are placed.
• Your child's surgeon will tell you when you can stop using the cuffs.

Ask your surgeon when it is safe to go swimming. Children may have ear tubes and, if so, you will need to keep water out of their ears.

Follow-up Care

Your health care provider will refer your child to a speech therapist. The provider may also make a referral to a dietician. Most times, speech therapy lasts 2 months. You will be told when to make a follow-up appointment.

When to Call the Doctor

Contact your surgeon if:

• Any part of the incision is opening or stitches come apart.
• The incision is red, or there is drainage.
• There is any significant bleeding from the incision, mouth, or nose. If bleeding does not stop with gentle pressure, go to the emergency room or call 911 or the local emergency number.
• Your child is not able to drink any liquids.
• Your child has a fever of 101°F (38.3°C) or higher.
• Your child has a fever that does not go away after 2 or 3 days.
• Your child has problems breathing.

References

Costello BJ, Ruiz RL. Comprehensive management of facial clefts. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery. 3rd ed. St Louis, MO: Elsevier; 2018:chap 28.

Shaye D, Liu CC, Tollefson TT. Cleft lip and palate: an evidence-based review. Facial Plast Surg Clin North Am. 2015;23(3):357-372. PMID: 26208773 pubmed.ncbi.nlm.nih.gov/26208773/.

Wang TD, Milczuk HA. Cleft lip and palate. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 188.

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