Dr.

Ghada Abu Shosha

 The gastrointestinal (GI) system involves a long body
tract and numerous organs. Because it is so long and
diverse, a multitude of possible disorders can occur
along it, including both congenital disorders and
acquired illnesses.

 Because the GI system is responsible for taking in and

processing nutrients for all parts of the body, any
problem with the system can quickly affect other body
systems and, if not adequately treated, can affect
overall health, growth, and development.
 Health education is extremely important for children
with GI disorders and their families because it can be
difficult to appreciate the seriousness of GI illness.

 Often, parents are surprised to find that what they

thought was a simple has caused serious electrolyte
imbalances and possibly a life-threatening state for
their child. Some GI disorders require both parents
and child to learn new nutritional patterns.
 Complete closure of lip is at 35 days post-conception.
 Palate closure is not completed until 9 weeks post-conception.

 Cleft lip and palate: are variations of a type of clefting

congenital deformity caused by abnormal facial development
during gestation.

 A cleft is a fissure or opening-a gap. It is the non-fusion of the

body's natural structures that form before birth.
 A cleft lip may be just a small notch in the lip. It may
also be a complete split in the lip that goes all the way
to the base of the nose.

 A cleft palate can be on one or both sides of the roof of

the mouth. It may go the full length of the palate.
 A cleft lip or palate can be successfully treated with
surgery, especially so if conducted soon after birth or
in early childhood.
 If the cleft does not affect the palate structure of the
mouth it is referred to as cleft lip.
 Cleft lip is formed in the top of the lip as a small
gap or an indentation in the lip. It could be:
1. partial or incomplete cleft.
2. complete cleft.
3. Unilateral
4. bilateral.
6 month old girl The same girl, 1 The same girl, age 5
before going into month after the years old. Note how the Same girl, age 8
surgery surgery. scar gets less visible
to have her with age.
unilateral complete
cleft lip repaired.
 Cleft palate is a condition in which the two plates of
the skull that form the hard palate (roof of the mouth)
are not completely joined. The soft palate is in these
cases cleft as well. In most cases, cleft lip is also
present.
 Palate cleft can occur as:
1. complete (soft and hard palate, possibly including
a gap in the jaw).
2. incomplete (a 'hole' in the roof of the mouth,
usually as a cleft soft palate).
 The hole in the roof of the mouth caused by a cleft
connects the mouth directly to the nasal cavity.
 Family History: Cleft lip more likely to be inherited than cleft palate

 Race: More common in Native American, Hispanic & Asian patients

 Sex: Males 2x as likely to have cleft lip; Females 2x as likely to have

cleft palate

 Environmental factors: exposure of fetus to alcohol, cigarette smoke.

 Medications: phenytoin, sodium valproate, methotrexate.

 Maternal Nutrition Deficiencies: especially lack of folate

◦ Encourage use of prenatal vitamins.
 Three-dimensional ultrasound, can provide a clear
image of the malformation
 Complications:
 Feeding difficulties, altered dentition, delayed or

altered speech development, and otitis media.

 The infant with cleft lip may have difficulty forming

an adequate seal around a nipple in order to create the

necessary suction for feeding.
 Gagging, and nasal regurgitation of milk may occur

in babies with cleft palate.

◦ Nurses need to be sensitive when dealing with the family of a
baby with cleft lip and palate

◦ Try to remember this may be quite a shock and they may be

grieving the “healthy & normal” baby they wanted

◦ Encourage parents to do care for the baby.

◦ Listening to the parents concerns.

 Health history:
 Maternal smoking
 Prenatal infection
 Advanced maternal age
 Use of anticonvulsants, steroids, and other medications

during pregnancy.
 Promoting adequate nutrition
 Preventing injury to the suture line post operatively
 Encourage infant-parent bonding
 Provide emotional support.
 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.
Mead Johnson/Enfamil Cleft Feeder Special Needs Feeder / Haberman Feeder

Pigeon Feeder Dr. Brown’s Natural Flow to relieve gas

- Primary lip repairs can often be undertaken at three
months of age with palatal repairs around six months.

A team approach for therapy

1. Pediatrician
2. Speech Therapist
3. Dentist
4. Audiologist
5. Otolaryngologist
Cleft lip repair. The edges of the cleft between the lip and nose are cut (A and B). The bottom of
the nostril is formed with suture (C). The upper part of the lip tissue is closed (D), and the
stitches are extended down to close the opening entirely (E).
 Inguinal and umbilical hernia are defects that occur
during fetal development.
 Occur in 0.8% to 4.4% of children.
 Most commonly in premature infants.
 Boys are 3 to 10 times more likely to have an inguinal
hernia than girls.
 In most cases, the processus vaginalis fails to completely
close which then allows the abdominal or pelvic viscera to
enter the patent processus and travel through the internal
inguinal ring into the inguinal canal.
 The processus vaginalis is an out-pouching of the
peritoneal cavity that follows the inguinal canal down into
the scrotum or the labium majora.
 The persistent processus in itself does not indicate the
presence of a hernia. Bowel or other intra-abdominal
contents must come into the processus for it to
clinically become a hernia.
 Diagnosis of inguinal hernias in children can be difficult
unless there is an obvious scrotal hernia. Often the mother
discovers the hernia when the child is coughing or crying.

 Once the diagnosis of an inguinal hernia is made in a child

it should be repaired.
 Surgical correction is usually performed.
 Occurs in 10% to 30% of term infants but up
to 75% of preterm infants.
 An umbilical hernia is caused by an
incomplete closure of the umbilical ring,
allowing intestinal contents to herniate
through the opening.
 Umbilical hernias in children result from a weakness in
the abdominal wall that is present at birth. The bulge in
the umbilicus may be present all the time or may only
be noticed when the child is crying, coughing, or
straining during a bowel movement. It may disappear
when the child is quiet.
 Most children will have spontaneous closure of the
umbilical hernia by age 5
 Surgical correction is necessary only for the largest

umbilical hernias that have failed to close by age 5

years.