Care of the Child with Cleft Lip and Cleft Palate

Abstract

IT IS impossible to overemphasize the importance of good nursing in the successful management of the child with a cleft lip, a cleft palate, or both. The effect of the nurse's contribution is felt whether the child is in the maternity hospital, on the surgical ward, at home, or at school. The newborn infant with a cleft lip and/or cleft palate faces certain major difficulties-first, in establishing and maintaining an adequate airway and second, but no less important, in taking food to maintain life. Later he will face the problems of communicating with others through the use of proper speech and of presenting a pleasing appearance. Obviously, the medical care of such a child begins at birth, and extends through his school years and well into his early adult life. In the past 15 years, 2635 operations for the correction of a cleft lip or palate have been performed at the Children's Medical Center in Boston, Mass. The procedures we will describe are those developed in the plastic surgical unit there, where the routines of preoperative and postoperative care have become well-established (1, 2). Very few other types of surgery require more painstaking nursing care. The same quality of meticulous perfectionism necessary in superior plastic surgery is essential in the supportive care of these patients. The various types of operative procedures, and the considerations involved in selecting the age for repair, will not be discussed here; they have been described in detail elsewhere (1, 2, 3, 4, 5). Our policy is to repair a cleft lip when the baby weighs at least six pounds, shows a steady gain in weight, is in good health, and is between four and six weeks of age.