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Table 5-15

Dimension	Cleft Lip Only	Cleft Palate Only	Both Cleft Lip and Cleft Palate
Incidence	1/7800 More common among boys	1/2000 More common among girls	Most common facial malformation More common among boys More common among Caucasians than African Americans
Surgical repair	“Cheiloplasty” Often done in a single stage Timing: age 6–12 weeks	Palatoplasty Often done in staged repairs Timing: age 12–18 months (controversial; usually done prior to development of faulty speech habits)	Lip always repaired before palate to enhance parent-infant attachment, bonding
Position postoperatively	Never on abdomen	Always on abdomen
Feeding postoperatively	No sucking Use Breck feeder or Asepto syringe	No sucking Use wide-bowl spoon or plastic cup
Nursing care postoperatively	Elbow restraints Lessen crying	Elbow restraints Lessen crying	OK to show parents pictures of “before” and “after” repair
Long-term concerns	Bonding, attachment Social adjustment—potential threat to self-image	Defective speech—refer to speech therapist Abnormal dentition—refer to orthodontist Hearing loss—refer to pediatric eye, ear, nose, throat specialist/physician