Professional Documents
Culture Documents
NRS210 Stu01
NRS210 Stu01
Considering the cleft deformities of all races grouped together, 50% are
cleft lip and palate, 30-35% are palate only, and 15-20% are cleft lip only.
The cleft palate was not recognized as a congenital disorder
until 1556.
More boys than girls have a cleft lip, while more girls have
cleft palate without a cleft lip.
feeding
Misaligned teeth
Poor growth
Recurrent ear infections
Speech difficulties
Cleft lip:
◦ Caused by incomplete fusion of the nasomedial or intermaxillary process
during the 2nd month of embryonic development
◦ Cleft causes structures of mouth and face to develop without the normal
restraints of encircling lip muscles
◦ May affect external nose, nasal cartilages, nasal septum, and alveolar
processes also
◦ More complete the cleft lip, the greater the chance that teeth in the line of
the cleft will be missing or malformed
Complete cleft= entire thickness of the lip
Incomplete cleft= only a portion of the lip is involved
Cleft Palate:
◦ Often associated with cleft lip, but may occur without it
◦ Fissure may affect only the uvula and soft palate (secondary palate, formed ~ 9
weeks), or may extend forward to the nostril and involve the hard palate and the
maxillary alveolar ridge (primary palate, formed ~ 4-5 weeks )
◦ Unilateral= on one side the palatal process of the maxilla is fused with the nasal
septum
◦ Bilateral= not attached to the nasal septum, and the septum is visible through the
cleft
◦ Cleft occupies the midline posteriorly and can go as far forward as the alveolar
process. Clefts involving the palate only are usually midline
◦ Some cases, the vomer and nasal septum are partly or completely undeveloped
When these facial bones are involved, the nasal cavity and the oral cavity are open to each other
South Africa:
◦ 2006 study: participants included 35 cleft patients and their families
Beliefs about the cause:
God
Witchcraft
Ancestors punishing the mother
Fate
Genetics and family history of the condition
Both groups reported that their patients came to traditional healers because they were
looking for comfort, or to be relieved of guilt because of their culture and what their
ancestors did
Some view a cleft as a gift from God, while others view it as a curse
Many beliefs exist about the role different foods play in causing or
healing physical problems
Ex/ eating hare while pregnant could cause a cleft lip
Depending on the belief regarding the cause of the cleft, patient may
feel shame
Latino
◦ Article focused on Latino people (from Mexico, Central and
South America, and the Caribbean) who are living in the
United States
◦ feeding difficulties
Feeding difficulties occur more with cleft palate abnormalities. The infant may be
unable to suck properly because the roof of the mouth is not formed completely.
◦ dental problems
As a result of the abnormalities, teeth may not erupt normally and orthodontic
treatment is usually required.
Infant with a Cleft Lip and Palate using a Pigeon system bottle, which encourages “active”
feeding.
The baby still has to suck, but not as hard and there is a one way valve that doesn’t allow milk
to go back into the bottle after it has been sucked through.
This helps the child later on with feeding after surgery has been complete since the baby has
already taken an active roll in eating.
Corpak’s are also utilized to provide the baby nutrition without burning so many calories.
Most NICU protocols will not allow the nurse to try to feed for more than 20 minutes.
The remainder of the bottle is then corpaked.
Breastfeeding can still be accomplished but it is recommended to consult a lactation educator
before attempting.
There may be many people involved in management of a cleft abnormality,
because the skills of many different areas are needed to help with the problems
that can occur with cleft abnormalities. The following are some of the members
of the team:
◦ Plastic/craniofacial surgeon- a surgeon with specialized training in the diagnosis and
treatment of skeletal abnormalities of the skull, facial bones, and soft tissue; will work
closely with the orthodontists and other specialists to coordinate a surgical plan.
◦ Pediatrician- a physician who will follow the child as he/she grows and help coordinate
the multiple specialists involved.
◦ Orthodontist - a dentist who evaluates the position and alignment of the child's teeth
and coordinates a treatment plan with the surgeon and other specialists.
◦ Pediatric Dentist - a dentist who evaluates and cares for the child's teeth.
Nutrition
◦ Assess the infant's nutritional intake, adequate amount of nutrients is necessary to maintain
growth
◦ Feeding is best accomplished in an upright position
◦ Special nipples or other feeding devices may be needed
◦ Breastfeeding is usually a viable option and sometimes more successful than bottle-feeding
◦ Avoid the use of suction or objects in the mouth such as thermometers, spoons or straws
Coping
◦ Address parent's emotional needs, answer and acknowledge questions and concerns
◦ Provide support to the child and the family members
◦ Promote attachment/bonding
◦ Emphasize positive aspects of baby's appearance
◦ Express optimism
The exact cause of cleft lip and palate is
unknown but it is believed to be a
combination of genetic (inherited) and
environmental factors.
◦ Cleft Palate= may cause formula or breast milk to be accidently taken up into the nasal cavity
don’t feed baby without palatal obturator (prosthetic palate)
feed in an upright position to keep milk from coming out of the nose
◦ Babies are more susceptible to altered nutrition (inadequate) related to difficulty eating due to
physical defect
SPEECH
◦ Muscle function is decreased and cleft lip or palate makes it more difficult for the child to
form words properly
need to see a speech therapist at 18 – 24 months
Mead Johnson/Enfamil Cleft Feeder Special Needs Feeder / Haberman Feeder