7 Cleft Lip and Cleft Palate Nursing Care Plans

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A cleft lip and palate is a defect caused by the failure of the soft and bony tissue to fuse in utero. These may occur singly or together and often occur with other congenital anomalies such as spina bifida, hydrocephalus, or cardiac defects. 

In infants diagnosed with cleft lip, 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 structures up into the floor of the nose, with even the upper teeth and gingiva absent. Cleft lip deformities can occur unilaterally, bilaterally, or rarely in the midline.

A cleft palate is an opening of the palate and occurs when the palatal process does not close as usual at approximately weeks 9 to 12 of intrauterine life. The incomplete closure is usually on the midline and may involve the anterior hard palate, the posterior soft palate, or both. It may occur as a separate anomaly or in conjunction with a cleft lip.

Treatment consists of surgical repair, usually of the lip between 6 to 10 weeks of age, followed by the palate between 12 to 18 months of age. The surgical procedures depend on the child’s condition and physician preference. Management involves a multidisciplinary approach that includes the surgeon, pediatrician, nurse, orthodontist, prosthodontist, otolaryngologist, and speech therapist.

Nursing Care Plans

Nursing goals for clients diagnosed with cleft lip and palate include maintaining adequate nutrition, increasing family coping, reducing the parents’ anxiety and guilt regarding the newborn‘s physical defects, and preparing parents for the future repair of the cleft lip and palate.

Here are seven (7) nursing diagnoses and nursing care plans (NCP) for cleft lip and cleft palate:

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  1. Ineffective Airway Clearance
  2. Imbalanced Nutrition: Less than Body Requirements
  3. Anxiety
  4. Deficient Knowledge
  5. Compromised Family Coping
  6. Risk for Injury
  7. Risk for (Ear) Infection
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Ineffective Airway Clearance

Infants diagnosed with a cleft palate cannot suck effectively either because pressing their tongue or a nipple against the roof of their mouth forces milk into their pharynx, possibly leading to aspiration. Additionally, because of the local edema that occurs after a cleft lip or palate surgery, it’s important to observe children closely in the immediate postoperative period for respiratory distress. After surgery, the infant has to learn to breathe through the nose, possibly adding to the respiratory difficulty.

Nursing Diagnosis

  • Tracheobronchial aspiration of feedings
  • The trauma of oral surgery

Possibly evidenced by

  • Abnormal breath sounds
  • Cyanosis
  • Dyspnea
  • Postoperative edema
  • Productive/non-productive cough
  • Respiratory rate and depth changes
  • Tachypnea

Desired Outcomes

  • The infant will maintain a clear airway as evidenced by clear breath sounds and the absence of cyanosis
  • The infant will display a respiratory rate of 20 to 30 breaths per minute, absence of retractions, and respiratory distress.

Nursing Assessment and Rationales

1. Assess the newborn’s respiratory rate, depth, and effort.
Aspiration of secretions or milk may cause tachypnea. Newborns are obligate nose breathers and show signs of distress if their nostrils become obstructed. The newborn’s respiratory rate can be observed most easily by watching the newborn’s abdomen because breathing primarily involves using the diaphragm and abdominal muscles.

2. Assess skin color and capillary refill.
Bluish discoloration of the skin or prolonged capillary filling happens because of the decreased oxygenation produced by the defect. The nurse should note, however, that the peripheral circulation of a newborn remains sluggish for at least the first 24 hours, which can cause cyanosis in the infant’s feet and hands (acrocyanosis).

3. Assess for abdominal distention.
The infant may swallow excess air during bottle feeding, causing abdominal distention that may result in upward pressure on the diaphragm and lungs, compromising respiration. To facilitate palpation (if not contraindicated), the knees and legs should be flexed toward the hips, which allows the abdominal muscles to relax.

Nursing Interventions and Rationales

1. Place the infant in an infant seat at 30° to 45°.
This position prevents the infant’s tongue from falling back and obstructing the airway. If possible, the infant can be placed in an infant bouncy seat. The semi-upright position facilitates burping, limits regurgitation of fluids, and prevents milk from entering the Eustachian tube and middle ear space, thus minimizing ear infections (Burca et al., 2016).

2. Position the infant in an upright position greater than 60° during feeding and elevate the head of the crib to 30° after.
General recommendations for body mechanics in infants with cleft lip or palate while feeding include the following: head support for neutral alignment of head and neck; arms forward, trunk midline, hips flexed; and lip, cheek, and jaw stabilization to provide a platform for sucking movements. Infants with cleft palate are fed in an upright position greater than 60° to allow gravity to facilitate fluid transfer and decrease the tendency for nasopharyngeal reflux (Burca et al., 2016).

3. Allow the infant time to swallow during feedings and provide oral care as appropriate.
Placing a small amount of breast milk or formula into the infant’s mouth and allowing time for swallowing will prevent aspiration. Offering small amounts of sterile water will cleanse the mouth after feeding. Formula or drainage is gently cleaned from the suture line with saline solution.

4. Provide oral and nasal suctioning as needed.
The purpose of suctioning is to maintain a patent airway and improve oxygenation by removing excess fluids and secretions in the oral and nasal cavities. Following either cleft lip or cleft palate surgery, infants may need their mouth suctioned to remove mucus, blood, and unswallowed saliva. When doing this, be exceedingly gentle, so you don’t touch the suture line with the catheter. Place the infant on their side to allow mouth secretions to drain forward.

5. Feed the infant slowly and burp frequently.
Burping frequently during feeding will reduce spitting up and prevent excessive swallowing of air. Holding the infant during feedings, burping frequently, and placing the infant in an infant seat after feeding or on the right side propped with a rolled blanket will aid in a positive outcome for this infant.

6. Position the infant appropriately after surgery.
Following a cleft lip repair, be sure the infant does not turn onto their abdomen because this could put pressure on the suture line, possibly tearing it. Careful positioning ensures the prevention of injury to the operative site.

7. Provide special nipples or feeding devices such as pigeon feeders with a one-way valve.
Feeding may work better using special bottles or nipples with a wider base. A syringe with a rubber tip, a long nipple with a large hole attached to a squeeze bottle, or a medicine dropper can be used to feed the infant formula or breast milk before and after surgery because sucking motions must be avoided to keep from applying tension on the suture line.

8. Coordinate with other health care teams for the holistic care and management of the infant.
Treatment of the infant diagnosed with cleft lip and palate requires multidisciplinary teamwork with a surgeon, pediatrician, pediatric dentist, orthodontist, nurse, psychologist, speech therapist, and social worker. The public health nurse should be responsible for coordinating parental counseling and referral as needed.

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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See Also

Other recommended site resources for this nursing care plan:

Other care plans related to the care of the pregnant mother and her baby:

References and Sources

  • Burca, N. D. L., Gephart, S. M., Miller, C., & Zukowsky, K. (2016, October). Promoting Breast Milk Nutrition in Infants With Cleft Lip and/or Palate. Advances in Neonatal Care, 16(5), 337-344.
  • Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans Guidelines for Individualizing Client Care Across the Life Span (8th ed.). F.A. Davis Company.
  • Kenner, C., Altimier, L., & Boykova, M. V. (Eds.). (2019). Comprehensive Neonatal Nursing Care. Springer Publishing Company.
  • Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing. Elsevier.
  • Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Wolters Kluwer. Tolarova, M. M., & Elluru, R. G. (2022, March 10). Pediatric Cleft Lip and Palate Clinical Presentation: Physical Examination. Medscape Reference. Retrieved July 18, 2022.

Reviewed and updated by M. Belleza, R.N.

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Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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