The Child w/

Alterations in
Nutrition/Metabolism
Report By:
Anita P. Prieto & Sugar Lynn M. Cafirma

Cleft Lip and Palate

Cleft Lip
-- Failure of the maxillary and median nasal processes to fuse normally.
The fusion fails to occur in varying degrees, causing this disorder to
range from a small notch in the upper lip to total separation of the lip
and facial structure up into the floor of the nose, w/ even the upper
teeth and gingiva absent.
The deviation may be unilateral or bilateral.
The nose is generally flattened because the incomplete fusion of the
upper lip has allowed it to expand in a horizontal dimension.
It is more prevalent among boys than girls.
It occurs as a familial tendency or most likely occurs from the
transmission of multiple genes
Formation may be aided by teratogenic factors present during weeks 5
to 8 of intrauterine life, such as a viral infection or possibly a deficiency
of folic acid.

Cleft Palate
An opening of the palate, is usually on the midline and may
involve the anterior hard palate, the posterior soft palate, or both.
It may be a separate anomaly, but as a rule it occurs in
conjunction w/ a cleft lip.
As a single entity, it tends to occur more on girls than boys.
It appears to be the result of polygenic inheritance or
environmental influences.
Assessment
Cleft Lip - may be detected by a sonogram while the infant is in
utero.
If not detected then it is readily apparent on inspection at birth.
Cleft Palate can be determined by depressing the newborns
tongue w/ a tongue blade.
This reveals the total palate and the extent of a cleft palate.

Therapeutic Management
If a Cleft Lip is discovered while the infant is still in utero, fetal
surgery can repair the condition, although this procedure is not
usually attempted.
If discovered at birth, it is repaired surgically shortly after birth,
sometimes at the time of the initial hospital stay or between 2
and 10 weeks of age.
Early repair also helps infants experience the pleasure of sucking
as soon as possible.
It is also important from a psychological standpoint that these
disorder be repaired early.
In Cleft Palate the repair is usually postponed until a child is 6 to 8
months old to allow the anatomic change in the palate contour
that occurs during the 1st year of life to take place.
Repairs made before this change ( the palate arch increases) may
be ineffective and may have to be repeated.

Tracheoesophageal Atresia and Fistula

Esophageal Atresia is obstruction of the esophagus. Often a Fistula

(opening) occurs between the closed esophagus and the trachea.
5 Usual types of Esophageal Atresia that occur are:
1. The esophagus ends in a blind pouch, there is a tracheoesophageal
fistula between the distal part of the esophagus and the trachea.
2. The esophagus ends in a blind pouch, there is no connection to the
trachea.
3. A fistula is present between an otherwise normal esophagus and
trachea.
4. The esophagus ends in a blind pouch.
A fistula connects the blind pouch if the proximal esophagus to the
trachea.
5. There is a blind end portion of the esophagus. Fistulas are present
between both widely spaced segments of the esophagus and the trachea

Assessment