MODULE 2- PEDIATRIC

COMMON HEALTH
PROBLEMS THAT
Common Congenital
DEVELOP DURING
Anomalies of the GI Tract
INFANCY
 Congenital Anomalies
Congenital anomalies can be defined as structural or
functional anomalies that occur during intrauterine life.
Also called birth defects, congenital disorders, or
congenital malformations, these conditions develop
prenatally and may be identified before or at birth, or later
in life.
 Congenital Anomalies
Occur in about 2% - 3% of all live births (Steele, 1997)
Increases to 6% by 5 years of age
 When more anomalies are diagnosed
Interdisciplinary team approach – vital for providing holistic care:
 Surgical treatment
 Rehabilitation and education of the child
 Psychosocial & financial assistance for the parents
o Parental disappointment and disillusion add to the complexity of the nursing care needed for
these infants.
 Gastrointestinal Anomalies
Most congenital gastrointestinal (GI) anomalies result in
some type of intestinal obstruction, frequently
manifesting with feeding difficulties, distention, and
emesis at birth or within 1 or 2 days.
 REVIEW!

Gastrointestinal tract, also

called digestive
tract or alimentary canal, pathway
by which food enters the body and
solid wastes are expelled.
The gastrointestinal tract includes
the mouth, pharynx, esophagus, 
stomach, small intestine, 
large intestine, and anus.
 Cleft Lip and Palate

Definition:
 Congenital facial malformation
characterized by non-fusion of facial
processes (cleft lip), and
 Non-fusion of tissue and bone of the
hard and soft palate (cleft palate)
happening during embryonic life.
Etiology:

Defective development of embryonic primary palate

occurring on 7th to 8th week of fetal life, and defective
development of embryonic secondary palate (cleft palate)
occurring about the 7th to 12th weeks of fetal life
Incidence:
 Cleft lip more frequent, males
 Cleft palate higher in females
Variations in cleft of lip and palate

A. Incomplete unilateral cleft of the lip

B. Unilateral cleft of the lip, alveolus, and
palate.
C. Bilateral cleft of the lip, and palate,
D. Isolated ( median ) cleft palate

Alveolus- is the bony socket for the root of

the tooth
Risk/Predisposing Factors

Multiple genetic factors

Environmental factors:
 Maternal infection (viral infections)
 Maternal obesity
 Hyperthermia
 Stress
 Smoking & Alcohol ingestion
 Treatment w/ meds like: corticosteroids, some tranquilizers, antiepileptics
Signs & Symptoms

Visible facial defect (cleft lip)

Visible defect on physical examination (cleft palate)
Sucking difficulties
Swallowing difficulties - feeding difficulty
Signs & Symptoms

Abdominal distention
Susceptibility to infection
 Respiratory (aspiration pneumonia),
 Mouth (oral thrush),
 Ear (otitis media)
Diagnostic Tests
 Sonogram while in-utero
 Physical assessment
Therapeutic Management

Correction/repair through plastic surgery in later

life
 Cheiloplasty – repair of cleft lip
Done in infancy: 2 – 3 mos (2 – 10 weeks, Pilliteri)
Often follows “RULE OF 10”
 10 weeks old
 10 lbs in weight
 10 gms in hemoglobin
Cheiloplasty
Uranoplasty/Palatoplasty

 Repair of cleft palate

 Best done in
toddlerhood before
speech training period:
18 – 36 months
Complications:
Speech problems/faulty speech/speech disturbance
Hearing problems/loss
Body image problems
Dental problem: malposition of teeth
Infection
Nursing Care

Provide preoperative care:

 Careful feeding: small, frequent, slow w/
infant in upright position; w/ frequent
burping, using appropriate feeding tools:
Cleft lip: rubber-tipped medicine dropper
or syringe
Cleft palate: large-holed, soft nipple or
paper cup
Specialty feeding devices

OBTURATOR
Preoperative Care:

Prepare parents for surgical procedures:

 Arrange for a multidisciplinary meeting to discuss the short- and
long-term plans of care
Provide psychological support:
 Be present during initial mother-newborn contact
 Don’t show discomfort in caring for infant
 Verbalize positive traits of infant
 Allow expression of feelings and concerns
 Show pictures of “before and after surgery”
Post-operative Care:
Maintain patent airway
 Position properly for drainage:
 Cleft lip: side-lying, never prone
 Cleft palate: prone, never supine
 Suction gently and carefully: insert suction catheter
along non-operative side
Prevent injury to suture line:
 Maintain Logan bar over suture line post cheiloplasty
 Proper position and positional changes
Post-operative care:
Apply bilateral elbow restraints
 Remove Q2 hrs, one @ a time, under supervision
 Provide arm exercises
 Prevent sucking – use rubber-tipped syringe/dropper, paper cup
Minimize crying
 Anticipate needs
 Soothing tactile stimulation
 Diversion
 Play activities – exc. Pacifiers, teethers
CONTINUE IN NEXT PPT