An operation to repair a cleft lip is usually done when your baby is between 3 and 6 months of age. The timing of the operation depends upon the type of cleft, the general health of your baby and if your baby needs orthodontic treatment (an orthodontic plate called a nasal alveolar molding).
Your baby will need a second operation to remove the sutures (stitches) that were placed in the first operation that fixed the cleft lip.
For more information on what a cleft lip is, please read Cleft lip and cleft palate in babies.
Preparing for your baby’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 baby’s health issues and develop a plan for the anaesthetic for the surgery. Some babies may need to meet with an anaesthesiologist in the Pre-Anaesthesia Clinic. You will be told which type of appointment your baby needs.
Follow the orthodontist’s instructions
If your baby is using an orthodontic plate and lip taping to prepare for the cleft lip repair, the orthodontist will give you instructions about when to stop lip taping before the operation. Your baby will need to keep the orthodontic plate in until the operation.
Pack a bag for your stay
You will need to bring your baby’s favourite toy or blanket, sleepers, bottles (if used), car seat and a stroller. Bring a comb, soap, shampoo and other toiletry items that you and your baby will need. If you plan to stay overnight, you may want to bring your own sleeping bag and pillow.
If you or your baby has any dietary restrictions or preferences, consider bringing these from home (e.g., special formulas, home cooked foods with the texture they are used to). Babies are sometimes picky about their formula or food after the operation. Having something familiar they like can help them recover and go home sooner.
Get your baby ready
You play an important role in reducing your baby’s risk of infection after their operation by bathing them before their operation. Bathing your baby reduces the number of germs that can cause an infection at the site of the operation. You will need to bathe your baby 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 baby will be given a general anaesthetic for the operation. This will help your baby fall into a deep sleep so they will not feel any pain or remember the operation. Your baby’s stomach must be empty before they have a general anaesthetic. You must follow the guidelines below to lessen the chance of your baby throwing up, which could hurt your baby's lungs.
- Your baby can have solid food until midnight the night before the operation.
- Your baby can have formula up to six hours before the operation, or breast milk up to four hours before the operation.
- Your baby 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 baby'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 baby’s operation
Plan to be at the hospital at least two hours before your baby’s operation so you can check in. You will be asked to fill in some forms with the nurse and your baby 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 baby a final time just before their operation. A nurse will explain this to you.
During the operation
A cleft lip 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 baby will be taken to the Post-Anaesthetic Care Unit (PACU), also called the recovery room. Your baby may spend one to two hours in the PACU. You may be able to see your baby for a short visit. When your baby is ready, they will be moved to the Plastic Surgery Unit.
After your baby's operation
Visiting and staying overnight at the hospital
In general, one parent can stay overnight with their baby 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 baby. If you are unsure, ask the nurse what to bring and what not to bring.
Your baby will look different
Be aware that your baby will look different after the operation. There may be some swelling and/or bruising around the lip and face. This could increase for up to two days after the operation but will go away within five to seven days. Your nurse and surgeon will answer any questions you may have about the way your baby looks.
Pain management after the operation
Your baby will have pain after the operation. Pain medicine will be given to help your baby feel more comfortable and feed. Your baby’s pain will generally be managed with a few different medications, including morphine, acetaminophen and ibuprofen. Your baby may be given pain medicine every four hours, as needed. You know your baby best. If you have concerns about your baby's pain, speak to the surgical and nursing staff.
Eating and drinking after the operation
After the operation, your baby will feed the same way as before the operation (breastfeeding or bottle feeding).
To make sure your baby is getting enough liquids, your baby will receive special liquids through their intravenous (IV) line. An IV is a small tube that is put in the vein of an arm or leg. The IV will stay in place until your baby can drink and keep liquids down.
Milk and other liquids
Your baby's first drink will be clear fluids or breast milk. Once your baby can keep this down, they can have formula.
Your baby may not want to drink at first or may take a longer time to feed following the operation. This may be because there is still some pain and swelling. Your baby may also have to get used to the new shape of their mouth and may need to adjust their suck, swallow and breathe pattern. To help your baby drink, the nurse may give them pain medicine about one hour before feeding. Your nurse, lactation consultant or an occupational therapist (OT) will help you feed your baby if there are problems or if you need help.
If your baby was wearing an orthodontic plate before the operation, they will no longer need it. It may take a little time for your baby to get used to feeding without the orthodontic plate.
Over time, feeding gets easier.
Solid foods
If your baby is eating purées you will need to make sure the suture line is properly cleaned after they have finished eating or drinking. See “Suture care” below for more details.
Positioning your baby: Awake and asleep
The head of your baby's bed will be raised slightly. This will help reduce swelling around their lip. Your baby will not be able to have time on their tummy because they could rub the suture line and slow down the healing process by causing wound breakdown.
Activity
Your baby must wear arm restraints after the operation to prevent them from putting their hands or other objects in their mouth. These arm restraints are soft, stiff sleeves that fit over your baby's arms and stop the elbows from bending. The arm restraints are put on your baby by the surgeon right after the operation. Your nurse will teach you how to use them. Your baby must wear these restraints 24 hours a day for up to three weeks after the operation. You may take off the restraints to bathe your baby.
Suture care
It is important that you keep the suture line clean. It is normal for a small amount of blood to ooze along the suture line for up to 24 hours after the operation. After each feed, you will need to clean the suture line with cotton swabs and water. You will also apply a thin layer of petroleum jelly to the suture line. Your nurse will teach you how to do this. Your baby will feel some discomfort during cleaning, but the baby's crying will not harm the sutures.
Nasal stents
Your baby may or may not have nasal stents in both nostrils after the operation. A nasal stent is a small, soft tube, about the thickness of a straw, which holds the nostril open. These tubes are usually sutured in place after the first operation. Your surgeon will discuss this with you, and your nurse will show you how to care for them. These sutures and the nasal stent will be removed when you return to the hospital to have the sutures in your baby’s lip removed.
Your baby will stay in the hospital for one or two days
Once your baby has recovered from the operation and you feel able to take over their care and they are feeding well, your baby can go home. Before you go home, you will be given the instructions you need to care for your baby and any follow-up appointment will be booked.
Helping your baby
Caring for your baby at home after the first operation
Once your baby returns home, please follow these instructions:
- Keep the arm restraints on your baby 24 hours a day, except during bathing, for up to three weeks after the operation.
- Gently clean the sutures with warm water and cotton swabs. Clean the sutures after each feed. Apply a thin layer of petroleum jelly.
- Protect your baby’s lip from harm (i.e., bumps and rubs):
- Your baby must not use a soother. The outside ring of the soother will rub the sutures and could cause wound breakdown.
- Your baby must not be on their tummy for three weeks after going home. As the wound heals, it can become itchy. If your baby is on their tummy, they are able to relieve the itch by rubbing the suture line. This can contribute to the breakdown of the sutures and can cause infection, and this can impact the quality of the scar.
- Be mindful when your baby is playing with older children to make sure there is no rough play. Flying objects, such as balls, may hurt your baby’s lip.
- If your baby has nasal stents sutured in, gently clean around them with warm water and cotton swabs after each feed. Apply a thin layer of petroleum jelly.
Suture removal operation
Return to hospital to get the sutures taken out
Your baby will need to return to the hospital seven days after the operation to have the sutures removed. Removing the sutures is another operation. Both the sutures in your baby's lip and the sutures holding the nasal stents in place will be removed. Like the cleft lip repair operation, your baby will have a general anaesthetic.
Follow feeding guidelines
As with the first operation, your baby must follow the feeding instructions previously described.
The operation will be booked for 30 minutes. After the operation, your baby will be taken to the recovery room.
Your baby may feel pain following the operation. You can give your baby acetaminophen every four hours as needed. Your nurse will give you more information about this.
Your baby will stay in the hospital for up to four hours from admission to discharge. Once your baby has recovered from the operation and you feel able to take over their care and they have begun to feed, your baby can go home.
Caring for your baby at home
Once your baby returns home, please follow these instructions:
- Keep the arm restraints on your baby 24 hours a day for two more weeks.
- Clean the incision line after each feed. You should clean the incision line with cotton swabs and warm water. Apply a thin layer of petroleum jelly. Do this for two more weeks.
- Your baby must not be on their tummy for two more weeks.
- Your baby cannot have a soother. Please check with your surgeon at the follow-up clinic visit when a soother can be used again.
If your baby is using nasal stents, remove them after each feed. Clean them with cotton swabs and warm water, and put them back in. Nasal stents should be worn 24 hours a day. For more information see Nasal stent after cleft lip surgery: Caring for your child at home.
A follow-up appointment
Your baby will return to see the surgeon three to four weeks after the cleft lip repair. You will be notified of this appointment once you are at home.
When to call the doctor
When at home, call the Plastic Surgery Unit, your baby's surgeon, or the cleft lip and palate nurse coordinator right away if your baby:
- Is not eating or drinking
- Has a fever
- Has redness or oozing from the suture line