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Part 4: Keeping Your Child Healthy  >  The A-Z of Childhood Illnesses  >  Cleft Lip and Palate

LEFT LIP AND PALATE

Cleft of the lip with or without cleft of the palate is a common birth defect. With surgery, these defects can be closed with good cosmetic effect.

The cleft lip is operated upon when the baby is about 3 months of age. Some plastic surgeons operating on these children follow a ‘rule of 10s’ to decide when to operate. They like the child to be at least 10 weeks of age, weigh 10 pounds (about 4.5 kg.) and have a haemoglobin of 10 grams per cent. The child should not have any infection. 

Surgery for cleft palate is usually undertaken between the ages of 1 and 2 years. Dr. K. S. Goleria, Plastic Surgeon at the Jaslok Hospital and Research Centre, Mumbai, operates cleft lip and cleft palate simultaneously with good results at 11 months of age.

These babies can be breastfed, though their mothers may need extra support. Most babies with only cleft lip (without cleft palate) have no difficulty in breastfeeding. The mother should offer enough of the breast into the baby’s mouth for the breast to close over the cleft so that he can suckle well. The idea is to help the mother use her areola (dark portion of the breast behind the nipple) to fill in the defect and form a seal.

Suckling is more difficult in the presence of a cleft palate. The baby may seem to choke sometimes, or milk may leak through the nose. The baby may choke less if the mother holds her baby in a more upright position while breastfeeding. If the baby is not able to manage direct suckling in one position, the mother should try feeding in a different position. One such position is called ‘the modified football-hold position’. In this position, the mother sits up on a bed. She makes the baby sit upright opposite her breast, with his legs along her side and his feet at her back. She holds his head in her hand to offer the breast and uses her other arm to support his back. A pillow kept under the baby’s bottom may be found to be helpful.

Direct suckling may not work with some babies. The milk should then be expressed and given to the baby in a cup or with a dropper (or by a tube) until the baby is able to suckle well enough at the breast. It has been found that irrespective of the mode of feeding, babies with cleft lip tend to gain weight rather slowly.

After surgery for cleft lip, some surgeons allow direct suckling from the breast as soon as the baby leaves the recovery room. They believe that, unlike bottle-feeding, the soft breast does not damage the stitches. In any case, there is no need to stop direct suckling for more than a few hours. If direct suckling is delayed for any reason, the mother should keep expressing her milk every 3 hours. This milk can be given to the baby with a cup or a bondla (paladai).

Breastfeeding is now recommended even in the second year of a child’s life. So after the child recovers from surgery for cleft lip, direct breastfeeding can be started again in a week or so. 

Some children who are operated for cleft lip may need another operation later on. After surgery, children with cleft lip and palate may need the help of a speech therapist and an orthodontist, under the guidance of a paediatrician.




7 March, 2016

 
Part 4
The A-Z of Childhood Illnesses

Abdominal Pain
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Cleft Lip and Palate
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Part 4
Keeping Your Child Healthy
Choosing A Paediatrician
Proper Use of Medicines
Home Remedies
A First Aid Kit
The A-Z of Childhood Illnesses
Psychological Concerns
Managing A Hospital Stay
Emergencies
Prayer And Your Child's Health
The Role of Nature Cure
Homoeopathy
Ayurveda and Child Care
Congenital Heart Disease FAQ
 
Guide to Child Care
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1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
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