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Your child had surgery to repair birth defects in a cleft lip, a cleft palate, or both. Your child had general anesthesia (asleep and not feeling pain) for the surgery.

Your child may have a stuffy nose and have to breathe through their mouth for the first week. There will be some drainage from their mouth and nose. The drainage should go away after about 1 week.

Clean the incision (surgery wound) after feeding your child.

• Use a cotton swab (Q-tip). Your doctor may give you a special liquid for cleaning the wound.
• Begin at the end that is closer to the nose.
• Always begin cleaning away from the incision and clean toward it. Do not rub right on the wound.
• If your doctor gave you an antibiotic ointment, put it on your child’s incision after you have cleaned it and it has dried.

Some stitches will go away on their own. The doctor or nurse will need to take others out. Do not remove your child’s stitches yourself.

You will need to protect your child's incision:

• Feed your child only the way your doctor or nurse told you.
• Do not give your child a pacifier.
• Babies will need to sleep in an infant seat, on their backs.
• Do not hold your child with their face toward your shoulder. They can bump their nose and harm their incision.
• Keep all hard toys away from your child.

Young infants should be eating only breast milk or formula.

Use a cup or the side of a spoon for giving your child drinks. If you use a bottle, use only the kind of bottle and nipple that your doctor has recommended.

Older infants or young children will need to have their food softened or pureed (mixed in a blender or food processor) for some time after surgery.

If your child is eating foods other than breast milk or formula, they should be sitting when they eat. Feed them only with a spoon. Do NOT use forks, straws, chopsticks, or other utensils that can harm the incision.

All your child’s foods should be smooth. Use a blender or food processor to prepare food for your child.

There are many good food choices for your child after surgery. Always make sure foods are cooked until they are soft, or use a blender. Good foods include:

• Cooked meats, fish, or chicken. Blend with broth, water, or milk.
• Mashed tofu, small curd cottage cheese
• Formula, milk, creamy soups, pudding, and yogurt
• Cooked cereals and baby foods
• Mashed potatoes (make sure they are smooth and thinner than normal)
• Gelatin

Foods your child should NOT eat:

• Seeds, nuts, bits of candy, chocolate chips, or granola, plain or mixed in any food
• Gum, jelly beans, hard candy, or suckers
• Chunks of meat, fish, chicken, sausage or hot dogs, hard cooked eggs, fried vegetables, lettuce, fresh fruit, or solid pieces of canned fruit or vegetables
• Peanut butter, creamy or chunky
• Toasted bread, bagels, pastries, dry cereal, popcorn, pretzels. crackers, potato chips, cookies, or any other crunchy food

Your child may play quietly. Keep them from running and jumping until the doctor or nurse says it is okay.

Your child may go home with arm cuffs or splints. These will keep your baby from rubbing or hitting their incision. Your child will need to wear them most of the time for about 2 weeks. Put on the cuffs over a long-sleeve shirt. If you need to, tape them to the shirt to keep them in place.

• You may take the cuffs off 2 or 3 times a day. Take off only 1 at a time.
• Move your child's arms and hands around, always holding on and keeping them from touching the incision.
• Make sure there is no red skin or sores on your child’s arms under where the cuffs are placed.
• Your child’s doctor or nurse will tell you when you can stop using the cuffs.

Ask your doctor or nurse when it is safe to go swimming. Your child may have tubes in their eardrums and need to keep water out of their ears.

Your doctor or nurse will refer your child to a speech therapist. Most times, speech therapy lasts 2 months.

Call your doctor if:

• Any part of the incision is opening.
• The incision is red, or there is drainage.
• There is any bleeding from the incision, mouth, or nose. If bleeding is heavy, go to the emergency room or call 911.
• Your child is not able to drink any liquids.
• Your child has a fever of 101 °F or higher.
• Your child has any fever that does not go away after 2 or 3 days.
• Your child has problems breathing.

Orofacial cleft - discharge; Craniofacial birth defect repair - discharge ; Cheiloplasty - discharge; Cleft rhinoplasty - discharge; Palatoplasty - discharge; Tip rhinoplasty - discharge

Arosarena OA. Cleft lip and palate. Otolaryngol Clin North Am. 2007 Feb;40(1):27-60.

Friedman O, Wang TD, Milczuk HA. Cleft lip and palate. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 176.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.