Cleft lip and palate

If milk comes from a baby's nose as he sucks, suspect that he has a cleft palate. You will not be able to repair either a cleft lip or a cleft palate, but you should know how to manage a child who has one, and when to refer him.

Cleft lips are not too difficult to repair well. They may be: (1) incomplete, (2) complete, (3) premaxillary, (4) complete with a cleft palate. (1) and (2) cause no problem with breast feeding, and (3) seldom does, but (4) makes breast-feeding very difficult. If a baby cannot suck, get him on to breast milk with a cup and spoon. Refer him for repair when he is 5 kg.

Cleft palates are much more difficult to repair. This should be done at 12 to 18 months, before he tries to speak, and when he should be fit enough for a major operation, if he has been adequately fed. Breast-feeding is a major problem, except for minor clefts of the soft palate only, which need no treatment. Try a cup and spoon. If this fails, he will have to be fed through a nasogastric tube, until he is stronger, when cup and spoon feeding may be possible. Some contributors are against all feeding bottles at any time anywhere!

A special plate, supported by two wire arms on his cheek, can be constructed in the first few days of life, to bridge the gap in his cleft palate.