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
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
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.
11 February, 2013