Instructions after Cleft Palate Repair

Important information about cleft palate repair:

This surgery will close the cleft or hole in your child’s palate, or the space between the mouth and the nose. The tissues will be stitched together along the roof of the mouth. It takes about 3 weeks to finish healing. The stitches used will dissolve, so they do not need to be removed by the surgeon.

The soft and hard palate will be closed during this surgery. If your child has a cleft through the gum, the gum will not be closed at this time. It will be closed with a bone graft surgery when your child is older.

The closed palate will make it easier for your child to eat and speak. Some food and liquid may still leak through the nose though the cleft in the gums. Your child will be evaluated by the Cleft Palate Team regularly as speech develops, even after the cleft palate has been repaired. Children born with a cleft may need additional help developing proper speech techniques as their palate will always move a bit differently.

Patient instructions after surgery:

Drinking and eating

• After surgery, your child will have an IV (intravenous line) and it will stay in place until they are drinking well. Your child may drink from a cup. Use a sippy cup with a soft rubber spout.

• Your child will begin with a liquid diet and then move to pureed baby foods or soft foods. Your child may not have solid, crunchy foods for 3 weeks until cleared by their surgeon. Spoon feed your child by placing only the tip of the spoon in their mouth. Please do not allow your child to spoon-feed themself at this time. No forks or straws are permitted.

• If your child uses a pacifier, ask your surgeon when it is safe to use after surgery. If you bottle-feed your child, use the same bottle and nipple you used before surgery. There are no restrictions with breast feeding.

Safety

• Keep hands and toys away from your child’s mouth.

• Your child will have to wear No-Nos® (elbow splints) at all times for 2 weeks after surgery to keep their fingers away from their mouth. Remove the No-Nos every 2 hours while your child is awake and bend their elbow back and forth to ensure range of motion. Look at your child’s skin for redness or irritation to make sure the No-No’s are not wrapped too tight. The No-Nos may also be removed when you are watching your child closely.

Pain management

Your child may be in pain after surgery, but most pain can be well controlled. Sometimes we cannot help a child to be completely pain free, but we will help your child to be as comfortable as possible. During surgery, we will place long-acting pain medicine in the surgical sites to make these areas less painful after surgery. This medicine lasts 6 to 12 hours after surgery. Your child may have numbness and tingling at the surgical sites because of this medicine.

• You may give your child ibuprofen (Motrin®) liquid every 6 hours as needed for pain. Follow the dosing instructions on the label.

If at any time your child’s pain is not relieved with ibuprofen:

• You may give your child acetaminophen (Tylenol®) liquid every 4 hours as needed for pain. Follow the dosing instructions on the label.

If at any time your child’s pain is not controlled by either ibuprofen or acetaminophen alone:

• You can alternate doses of acetaminophen and ibuprofen every 3 hours. For example, if you give your child acetaminophen at noon, you can give ibuprofen at 3 p.m. and then acetaminophen again at 6 p.m. and ibuprofen again at 9 p.m. It is very important that you read and understand the dosing instructions of both medicines. You may not give more than 4 doses of ibuprofen in a 24 hour period. You may not give more than 6 doses of acetaminophen in a 24 hour period.

If at any time you child’s pain is not controlled with alternate doses of acetaminophen and ibuprofen:

• You may give your child oxycodone every 4 hours. Oxycodone is a narcotic, and it is very important that you understand and follow the dosing on the label for the oxycodone. Try to give fewer doses of oxycodone each day. The goal is to be off the oxycodone by 3 or 4 days after your child’s surgery.

Discharge

• Your child will be discharged home when they are drinking, breathing easily, and feeling comfortable. This usually happens in 1 to 2 days.

• Schedule a follow-up appointment with the plastic surgeon in 2-4 weeks. Starting at age 18 months, you will also schedule regular visits with the CHOP Cleft Palate Team.

Complications

As in any surgery, rare problems can occur which include bleeding, infections, breakdown of the repair, and reactions to medicine. In some children, for unknown reasons, the cleft palate repair will pull apart over time and a hole between the nose and the palate will develop. These problems are uncommon, and most of the time cleft palate repair surgery has good results.

Contact your CHOP surgical team with questions, concerns or if:

• Your child has signs of dehydration, including:

• They will not drink. We expect children to have slightly decreased oral intake on the day of surgery, but they typically go back to normal feeding patterns within 24 hours of surgery.

• They are wetting fewer diapers or urinating less often. Infants under 6 months of age should not go longer than 4 to 6 hours without urinating.

• They are difficult to soothe or appear weak

• Producing few or no tears when crying

• Your child has difficulty breathing or has long pauses of breathing when sleeping

• Your child has pain that does not get better after taking acetaminophen, ibuprofen and oxycodone

• Your child has signs of infection such as a temperature is 101ºF (38.3°C) or higher under the arm or 102ºF (38.8°C) or higher rectally

Division of Plastic, Reconstructive and Oral Surgery

Monday through Friday, 8 AM -5 PM

215-590-2208

Evenings, weekends, and holiday, call 215-590-1000 and ask to speak with the plastic surgery resident or fellow on call

Reviewed December 2023 by Kelsey Reilly, CRNP