Cleft Palate Repair

Your child needs an operation to fix a cleft palate. This page tells you what you need to know before, during and after the surgery.

Important information

Name of your child's surgeon:

Telephone number:

Examinations and tests in the weeks before the operation

Six weeks before the operation, take your child to your family doctor or paediatrician for a general physical examination. Your surgeon will give you forms for your child’s doctor to fill in. Please complete these forms and return them right away to your surgeon’s office. Your child will also need a blood test before the operation. Your family doctor will arrange this.

Your child must be able to drink from a cup

Before the operation, your child needs to be able to drink from a cup and no longer bottle feeds.

Before going to the hospital

The night before the operation, please give your child a bath and wash her hair. Your child will be staying overnight at the hospital after the operation. Many hospitals let a parent stay overnight. Please bring clothes, toys and toiletry items that you and your child will need for your stay at the hospital. Ask the nurse what services you can access during your stay.

A cleft palate repair operation usually takes about 2 to 3 hours

Your child will be given a "sleep medicine", also called a general anaesthesia, for the operation. This means she will be asleep and feel no pain during the operation.

Follow these feeding guidelines:

Your child may have solid food until midnight the night before the operation. Your child can have formula up to 6 hours before the operation or breast milk up to 4 hours before the operation.

Your child may then have clear fluids up to 3 hours before the operation. Examples of clear fluids are apple juice and water but not orange juice.

You must follow these feeding instructions to lessen the chance of throwing up, which could hurt your child's lungs.

If you do not follow these feeding guidelines, your child's operation will be cancelled.

If you do not understand these instructions, please call the clinic nurse a few days before the operation.

After the operation

When the operation is over, your child will be taken to a recovery room for about 4 hours. You will be able to visit your child. When your child is ready, she will be moved to the Plastic Surgery Unit.

Your child will spend the first night in a croupette. A croupette is a clear plastic tent which is put inside/in the crib. The air inside is kept misted so that your child will be more comfortable and can breathe more easily.

Pain management after the operation

If your child has pain after the operation, pain medicine will be given as needed. You know your child best. If you have concerns about your child’s pain, speak to the surgical and nursing staff.

Eating and drinking after the operation

To make sure your child is getting enough liquids, your child will receive special liquids through her intravenous (IV) line. An IV is a small tube that is put in the vein of an arm or leg. The IV will remain there until your child can drink and keep liquids down.

For the first 2 days after the operation, your child will only have liquids to drink. This will allow the sutures (stitches) to heal and help prevent infection. Some examples of liquids are water, apple juice, milk, strained baby foods, puddings, yogurt and ice cream. Please encourage your child to drink a lot. Your child may not want to drink because her mouth will be sore from the operation. To help your child, the nurse may give her pain medicine about 1 hour before eating.

On the third day after the operation, your child may have something soft to eat, such as spaghetti or mashed potatoes. These foods should not have big chunks in them. It is important for your child to eat and drink to speed healing. If you have questions about what your child will be eating after the operation, please ask your child’s nurse or surgeon.

You may feed your child with a spoon, but do not let your child eat on her own. Your child may use a training cup with a short spout, or an ordinary cup.

Food or liquids may come out your child’s nose when she is eating or drinking. Do not be alarmed. This is normal and may occur for several weeks after the operation until the suture line is completely healed.

Please do not give your child raw fruits or vegetables, candy, or anything hard to eat in the hospital and for 2 weeks after you return home. Do not use a bottle or pacifier (soother) and do not allow sharp objects such as a fork or straws in your child’s mouth.

Positioning your child: awake and asleep

The head of your child’s bed will be raised slightly. This will help reduce swelling in and around your child’s mouth. This will also help drain any blood and other fluids from your child’s mouth. This drainage may continue for up to 24 hours after the operation.

Activity

Your child must wear arm restraints after the operation to prevent her from putting hands or other objects in her mouth. These arm restraints are soft, stiff tubes that fit over your child's arms and stop the elbows from bending. Your nurse will give you the restraints and teach you how to use them. Your child must wear these restraints 24 hours a day for up to 3 weeks after the operation.

Mouth care

To help keep the suture line clean, give your child a drink of water after giving anything to eat or drink. This includes liquid medicines that your child receives.

The corners of your child’s mouth may be reddened and sore after the operation because the mouth has been stretched. This soreness will heal quickly. To help reduce soreness, you can apply Vaseline to the corners of your child’s mouth.

Ear tube operation

If your child has had ear tubes placed in her ears to drain the fluid, there may be some dried blood in the outer ear. This is normal. Do not be alarmed.

You will be given antibiotic drops to put in your child's ears. To use them, follow the instructions from your nurse or doctor.

Your child will stay in the hospital for about 2 days

Once your child has recovered from the operation and you feel able to take over her care, your child can go home. Before you go home, you will be given the instructions you need to care for your child. Any follow-up appointments should be scheduled before you go.

Caring for your child at home

Once your child comes home from the hospital, follow your surgeon's instructions for looking after your child:

  • Keep the arm restraints on your child 24 hours a day for up to three weeks after returning home.
  • To avoid damaging your child’s suture line, give her only soft foods for the first _____ weeks at home. Do not give your child foods that are hard or in big chunks. After _____ weeks, your child can eat her usual foods.
  • To keep your child’s mouth clean, give her a drink of water after eating or drinking. Do this for 2 weeks after your child is home from hospital.

When to call the doctor

Call the Plastic Surgery Unit or your child’s surgeon right away if your child:

  • is not eating or drinking
  • has a fever
  • is bleeding from the mouth
  • has a foul odour from the mouth

Following up at the hospital

Your child will return to see the surgeon, speech language pathologist, and the audiologist 6 weeks after going home. If your child has ear tubes, she will also have an appointment at the Ear, Nose and Throat (ENT) Clinic.

Key points

  • Fixing a cleft palate involves an operation.
  • Your child needs to be able to drink from a cup.
  • Your child will need to stay in the hospital for about 2 days after the operation.
  • Your child will need to wear arm restraints to stop her putting things in her mouth.
  • Your child will need to eat soft foods for the first few weeks at home.
  • Contact the Plastic Surgery Unit if you have any questions or if your child has signs of infection.

Cindy Guernsey RN, BScN

1/10/2011

At SickKids:

Please bring your child to unit 6B in the Atrium (Surgical Day Care Unit) 2 hours before the operation. You will fill in some forms with the nurse and your child will have a final assessment before the operation.

For general information about your child’s stay at The Hospital for Sick Children, please read The Family Guidebook.

If you have any further questions, please call the Cleft Lip and Palate Coordinator (416-813-7491) or the Plastic Surgery Unit (416-813-6932).

After the operation, your child will spend 4 hours in the recovery room. Then your child will be moved to the Constant Observation Room on 8C (Plastic Surgery Unit). Your child will be closely watched by a nurse. You can visit your child and sit by his or her bed. There will be a pull-out bed so that 1 parent can stay overnight.

The morning after the operation, your child may be moved to his or her room on 8C. In this room, there is a bed available for one parent or guardian to stay overnight.





Notes: