5 Cleft Lip and Cleft Palate Nursing Care Plans

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 and Management

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.

Nursing Problem Priorities

The following are the nursing priorities for patients with cleft lip and cleft palate:

  • Feeding Difficulties. Infants with cleft lip and cleft palate may have difficulties in breastfeeding or bottle feeding due to structural abnormalities. Ensuring adequate nutrition and addressing feeding challenges are crucial for their growth and development.
  • Speech and Language Development. Cleft lip and cleft palate can affect speech production and intelligibility. Early intervention by speech therapists and regular monitoring of speech and language development are essential to address any potential communication difficulties.
  • Dental and Orthodontic Issues. Cleft lip and palate can impact the alignment and development of teeth and jaws. Dental problems, such as malocclusion, missing teeth, and dental decay, may require orthodontic and dental interventions to ensure proper oral health and function.
  • Ear Infections and Hearing Problems. Children with cleft palate are more prone to middle ear infections (otitis media) and hearing loss due to the dysfunction of the Eustachian tube. Frequent monitoring and timely intervention are necessary to prevent potential hearing impairment.
  • Psychological and Social Well-being. Individuals with cleft lip and cleft palate may face challenges related to self-esteem, body image, and social interactions due to visible facial differences. Providing psychological support and addressing any emotional difficulties can contribute to their overall well-being.
  • Facial Aesthetics and Plastic Surgery. Reconstructive surgery plays a vital role in correcting the cleft lip and palate, improving facial aesthetics, and restoring normal function. Surgical interventions are typically staged and performed by experienced plastic surgeons.
  • Nasal Resonance and Breathing Difficulties. Cleft palate can affect nasal resonance and lead to nasal airway obstruction. Management may involve speech therapy, nasal surgery, and continuous monitoring of nasal function.
Paul Martin R.N. brings his wealth of experience from five years as a medical-surgical nurse to his role as a nursing instructor and writer for Nurseslabs, where he shares his expertise in nursing management, emergency care, critical care, infection control, and public health to help students and nurses become the best version of themselves and elevate the nursing profession.

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