An operation to repair a cleft palate is usually done when your child is between 11 and 14 months of age. The timing of the operation depends on the general health of your child. A cleft palate needs to be repaired in order for your child to develop normal speech.
Many children with a cleft palate have fluid in their middle ears. This can affect the child’s hearing. In order for children to learn how to speak, they need to be able to hear well. For this reason, many children with a cleft palate will also have tubes inserted in their ears to drain the fluid. This will be done at the same time as their palate repair by an ear, nose and throat specialist called an Otolaryngologist.
For information on what a cleft palate is, please read Cleft lip and cleft palate in babies.
Pre-palate appointments at 9 months of age
Your child will have several appointments to prepare for their cleft palate operation. Your child will be booked to see:
- Plastic surgeon: Will talk to you about your child’s cleft palate repair.
- Plastic surgery clinic nurse: Will talk to you about the pre and postoperative care so you are prepared to take care of your child after the operation.
- Occupational therapist: Will provide you with information for transitioning your child from the special bottle to a sippy cup before the operation. Using a bottle or having your baby use suction will be harmful to the area of the palate being repaired.
- Pediatric dentist: Will check your child’s teeth and teach you how to care for them. It is important that your child’s teeth are free of cavities before the operation.
- Speech-language pathologist: Will assess your child’s communication skills and provide suggestions for supporting speech and language development.
- Audiologist: Will check your child’s hearing.
- Otolaryngologist: Will review your child’s hearing test and check your child’s ears for fluid behind the eardrum. If there is fluid and it is affecting hearing, they will talk to you about inserting tubes in the ears, in the same operation, as the palate repair.
Preparing for your child’s operation
Complete a pre-anaesthesia assessment
The pre-anaesthesia assessment is usually done as a phone call. A doctor or nurse practitioner will review your child’s health issues and develop a plan for the anaesthetic for the surgery. Some children may need to meet with an anaesthesiologist in the Pre-Anaesthesia Clinic. You will be told which type of appointment your child needs.
Pack a bag for your stay
You will need to bring your child’s favourite toy or blanket, sleepers, sippy cups, car seat and a stroller. Bring a comb, soap, shampoo and other toiletry items that you and your child will need. If you plan to stay overnight, you may want to bring your own sleeping bag and pillow.
If you or your child has any dietary restrictions or preferences, consider bringing puréed food from home (e.g., special formulas, home cooked foods that are blended). Children are sometimes picky about their formula or food after the operation. Having something familiar they like can help them recover and go home sooner.
Make sure you bring a sippy cup(s) with a short soft spout that is less than one inch in length. The sippy cup should allow a free flow of contents when turned upside down without your child having to squeeze or suck at the spout.
Get your child ready
You play an important role in reducing your child’s risk of infection after their operation by bathing them before their operation. Bathing your child reduces the number of germs that can cause an infection at the site of the operation. You will need to bathe your child and wash their hair with shampoo twice before their operation: The first time 48 hours before the operation and the second time 24 hours before the operation.
Follow the feeding guidelines
Your child will be given a general anaesthetic for the operation. This will help your child fall into a deep sleep, so they will not feel any pain or remember the operation. Your child’s stomach must be empty before they have a general anaesthetic. You must follow the guidelines below to lessen the chance of your child throwing up, which could hurt your child's lungs.
- Your child can have solid food until midnight the night before the operation.
- Your child can have formula up to six hours before the operation.
- Your child can have clear fluids up to three hours before the operation. Examples of clear fluids are clear apple juice and water, but not orange juice.
If you do not follow these feeding guidelines, your child's operation will be cancelled.
If you are unsure of these instructions, please call the clinic nurse or cleft lip and palate nurse coordinator a few days before the operation.
When to check in for your child’s operation
Plan to be at the hospital at least two hours before your child’s operation so you can check in. You will be asked to fill in some forms with the nurse and your child will have a final assessment before the operation.
Pre-operative bath
To help prevent infection, all children will have a pre-operative bath using pre-packaged wipes. You will be given a package of bathing wipes to bathe your child a final time, just before their operation. A nurse will explain this to you.
During the operation
A cleft palate repair operation usually takes about three hours.
During the operation, you can wait in the Surgical Waiting Room. The surgeon will give you an update after the operation is finished.
When the operation is over, your child will be taken to the Post-Anaesthetic Care Unit (PACU), also called the recovery room. You may be able to see your child for a short visit. When your child is ready, they will be moved to the Plastic Surgery Unit.
Constant Observation Room
Your child will be moved to the Constant Observation Room on the Plastic Surgery Unit. Your child will be closely monitored by a nurse.
Visiting and staying overnight at the hospital
In general, one parent can stay overnight with their child during recovery. If you plan to stay overnight, you may wish to bring your own sleeping bag and pillow. The parent is responsible for bringing personal items they need during their stay with their child. If you are unsure, ask the nurse what to bring and what not to bring.
Pain management after the operation
Your child will have pain after the operation. Pain medicine will be given to help your child feel more comfortable and feed. Your child’s pain will generally be managed with a few different medications, including morphine, acetaminophen and ibuprofen. Your child may be given pain medicine every four hours, 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
Your child may not want to eat or drink after the operation. This may be because they are in pain. It will be important for your child to have pain medicine about one hour before eating.
About 24 hours after the operation, your child will only have clear fluids to drink. This will allow the sutures to heal and help prevent infection. Some examples of clear fluid are water, apple juice and clear broth.
On the first day after the operation, your child may have various liquids including clear fluids, milk, strained baby foods, puddings, yogurt and ice cream.
On the second day after the operation, your child will be able to eat puréed foods. Your child may have regular food such as pasta, meat, etc. as long as it is blended with the same consistency as baby food. Your child should continue on a puréed diet for six weeks after the operation.
It is important for your child to eat and drink to help with healing. In order to protect the area of operation and allow it to heal:
- Do not give your child raw fruits or vegetables, candy, or anything hard or sticky to eat for six weeks. An example of sticky food includes peanut butter.
- Do not use a bottle or pacifier (soother).
- Do not allow sharp objects such as a fork or straw in your child’s mouth. You may feed your child with a spoon.
- Do not let your child feed themselves or have an older sibling/child feed them.
- Your child may use a free-flowing sippy cup with a short spout, or an ordinary cup.
Liquids or food coming out the nose
Food or liquids may come out your child’s nose when they are eating or drinking. Do not be alarmed. This is normal and may occur for several weeks after the operation until the incision line is completely healed.
Drainage from the mouth
There may be some blood and other fluids draining from your child’s mouth. This is normal and may continue for 24 to 48 hours after the operation. Your child will be placed to sleep on their tummy. This will help drain the fluid.
Mouth care
It is important that you keep the area of the operation clean. You will need to help keep your child’s mouth clean. This means your child will need to take a drink of water after having anything to eat or drink. This includes liquid medicines that your child receives. Your nurse will teach you how to do this.
Corners of mouth
The corners of your child’s mouth may be reddened and sore after the operation because the mouth has been stretched to help the surgeon see the palate during the operation. To help the area heal you can apply petroleum jelly to the corners of your child’s mouth. This will get better within a few days.
Activity
Your child must wear arm restraints after the operation to prevent them from putting their hands or other objects into their mouth. These arm restraints are soft, stiff sleeves that fit over your child's arms and stop the elbows from bending. The arm restraints are put on your child by the surgeon right after the operation. Your nurse will teach you how to use them. Your child must wear these restraints 24 hours a day for up to three weeks after the operation. You may take off restraints to bathe your child.
Ear tubes
If your child had drainage tubes inserted in their ears, 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 ear. Follow the instructions from your nurse or doctor on how to use them. It is important that you finish all the antibiotic drops.
Your child will stay in the hospital for two or three days
Your child will stay in the hospital for two or three days. Once your child has recovered from the operation and you feel able to take over their care, your child can go home. Before you go home, you will be given the instructions you need to care for your child and any follow-up appointments will be booked.
Caring for your child at home after the operation
Once your child returns home, please follow these instructions:
- Keep the arm restraints on your child 24 hours a day, except during bathing, for up to three weeks after the operation.
- Protect your child’s palate from harm:
- Your child must not use a soother. The soother will rub areas of the palate and may cause wound breakdown and poor wound healing.
- Your child must use a sippy cup that has a soft spout that is less than an inch in length. The sippy cup should be free-flowing without having to squeeze or suck at the spout.
- Your child may also use a regular cup.
- Continue on puréed food for a total of six weeks after the operation:
- Do not give your child food that is sticky, hard or in big chunks.
- To keep your child’s mouth clean, give them a drink of water after eating or drinking. Do this for six weeks after your child is home from the hospital.
- After six weeks, your child can eat their usual foods.
- Keep your child comfortable by giving pain medications, as needed.
- It may be helpful for your child to sleep on their tummy for two weeks after returning home.
- If your child has ear tubes inserted:
- Give antibiotic ear drops as prescribed.
- Do not insert anything in your child’s ear including cotton swabs.
- Your child can have a bath.
- To prevent ear infections, avoid getting soapy water into your child’s ears. To protect your child’s ears, use silicone ear putty or ear plugs during bathing and shampooing.
- Talk to your Otolaryngologist about when your child can swim.
Follow-up with the surgeon and speech-language pathologist
Your child will have an appointment with the surgeon and speech-language pathologist six to eight weeks after going home.
Your surgeon will check your child’s palate to make sure it is healing properly.
The speech-language pathologist will assess your child’s communication skills, provide suggestions for supporting speech and language development and refer your child to the Preschool Speech and Language Program where you live.
Follow-up with the audiologist and otolaryngologist Your child will have an appointment with the audiologist and otolaryngologist six months after the operation.
If tubes were inserted, it is recommended that your child have a follow-up visit every six months to make sure the tubes are working, and your child is hearing well. It is important for your child to have good hearing in order for them to develop normal speech.
If tubes were not inserted, your child will have a hearing test at 18 months of age to make sure that your child is hearing well.
When to call the doctor
When at home, call the Plastic Surgery Unit, your child's surgeon, or the cleft lip and palate nurse coordinator right away if your child:
- Is not eating or drinking.
- Has a fever.
- Has a foul smell from the mouth.
- Has fluid leaking from their ears more than four days after the operation.
At SickKids
Please bring your child to unit 6B in the Atrium (Surgical Day Care Unit) two 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 four 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 their bed. There will be a pull-out bed so that one parent can stay overnight.
The morning after the operation, your child may be moved to their room on 8C. In this room, there is a bed available for one parent or guardian to stay overnight.