Running head: DEFINING AND CARING FOR CLEFT PALATE

Defining and Caring for Cleft Palate

Daniel M. Meyers

Brigham Young University – Idaho

Nursing 410

Professor Forbush

November 18, 2018

DEFINING AND CARING FOR CLEFT PALATE 2

Defining and Caring for Cleft Palate

Introduction to Cleft Palates

Every year 4,440 babies are born with a cleft lip with or without a cleft palate in the

United States. Many people believe that this is a congenital abnormality that does not occur in

developed countries. Rather, they believe that this is a physical anomaly that can only occur in an

underdeveloped place with poor nutrition. While, this malformation definitely does occur in

greater numbers in underdeveloped countries it still exists here in the western world. As this

essay progresses the following points should become evident. This essay will address what cleft

palate is, what causes cleft palate, how it affects growth and development, how it is treated, and

important educational points for patients and parents of children with cleft palate.

Defining Cleft Palate and its Cause

Cleft palate is an oral malformation that develops during the early stages of pregnancy. It

is an obvious congenital defect at birth and occurs due to the failure of the lateral palatine

processes, nasal septum, or the median palatine process, fusing together (Mayo Clinic, 2018).

While the true cause behind cleft palate formation is unknown, theory exists on what factors

contribute to its occurrence. Research has determined some causes of cleft palate that may

include the following: women who smoke during pregnancy, women diagnosed with diabetes

before pregnancy, and certain medications such as topiramate or valproic acid (Center for

Disease Control and Prevention, 2017). Other research has determined that genetics, maternal

alcohol consumption, and lack maternal folic acid consumption may also play a role in its

development (Reiter et al., 2012). As previously stated, the exact environmental cause of cleft

palate remains undetermined. However, research continues to discover links and potential causes

to its development.
DEFINING AND CARING FOR CLEFT PALATE 3

Growth and Development

While cleft palate is not associated with high morbidity, there are many aspects of this

malformation that can affect the growth and development of this children. Perhaps the most

immediate concern is the infant’s difficulty in feeding. While infants with a cleft lip retain the

ability breast-feed, infants with cleft palate have an extremely difficult time sucking. Because of

this, infants with this malformation may have impaired growth due to decreased caloric and

nutritional intake. Other growth and development complications associated with this

malformation include dental problems, speech difficulty, and frequent ear infection. If the cleft

extends through the gums this can greatly affect the normal dental development. Also, the palate

is used in the formation of sound. Because of this, individuals with cleft palate also have

difficulty in articulating words and their speech may never develop normally (Mayo Clinic,

2017). There is a plethora of ways that cleft palate can affect normal growth and development,

but these are among the most common areas of growth affected by this malformation.

Treatment

Surgery is the only way to truly rectify a cleft palate. This surgical repair typically takes

place before twelve months of age to enhance normal speech development. The two main

surgeries performed to correct this malformation are the Veau-Wardill-Kilner V-Y pushback

procedure and the Furlow-double-opposing Z-plasty. Even after these surgical repairs some

infants may need secondary procedures. Typical secondary procedures are palatal lengthening,

pharyngeal flap, sphincter pharyngoplasty, or posterior pharyngeal wall augmentation (Rudolf et

al., 2018). While there are other surgical procedure used to correct this defect, these are among

the most commonly used.

Education
DEFINING AND CARING FOR CLEFT PALATE 4

There are many points of teaching that need to occur when helping parents of children

with a cleft palate. There are vital educational points around the surgical procedure, and in the

long-term care of the child. During the preoperative stage, parents can be educated on the use of

alternative feeding systems. To obtain the correct nutrition the child may need a nasogastric tube

or be fed via a syringe. During the postoperative phase, teaching is directed towards protecting

the operative area. Many children will be placed in elbow immobilizers to prevent the child from

damaging the area (Rudolf et al., 2018). It is important that parents are adequately educated on

the purpose of these restraints. In the time that follows surgery, multiple points should be

addressed to help the child obtain normal development. Speech therapy, adequate mouth care,

and esteem support will all be important points of education as the child develops.

Conclusion

Cleft palates are among the most common birth defects worldwide and have many

aspects to their care that may not be considered. While the cause of their development is

unknown there are environmental aspects that should be avoided to aid in its prevention. Surgical

repair will be necessary, and parents will need education and guidance on how to best care for

their child with this malformation.

DEFINING AND CARING FOR CLEFT PALATE 5

References

Centers for Disease Control and Prevention. (2017). Facts about cleft lip and cleft palate.

Retrieved from https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

Mayo Clinic. (2018). Cleft lip and cleft palate. Retrieved from

https://www.mayoclinic.org/diseases-conditions/cleft-palate/symptoms-causes/syc-

20370985

Perry, S., Lowdermilk, D., Cashion, K., Alden, K., Olshansky, E., Hockenberry, M., Wilson, D.,

Rodgers, C. (2018). Maternal child nursing care. St Louis, Missouri: Elsevier Inc.

Rudolf, R., Sibylle, B., Manuel, L., Elena, F., Stephan, H., Anja, P., Gunter, A., Anke, A.,

Walther, V., Josef, H., Christiane, M. (2012). Genetic and environmental risk factors for

submucous cleft palate. Wiley Online Library, 120(2), 97-103. DOI:

10.1111/j.1600-0722.2012.00948.x