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The article was professionally consulted with Master, Specialist I Tran Tuyen - Pediatrician - Department of Pediatrics - Neonatology, Vinmec Central Park International General Hospital.Cleft palate is a defect that can be completely treated if the child is properly cared for and treated with patience. Caring for children with cleft lip and palate should be divided into stages with separate steps and attention in each stage of the child's development and treatment. The care of children with cleft palate requires the cooperation of doctors and parents during, before and after the surgical treatment period.
1. Neonatal care
For children with cleft lip and palate, the most difficult thing in care is breastfeeding. Because most children with cleft palate are unable to breastfeed as well as bottle feed like other normal children. Babies need a specialized bottle to drink breast milk and ensure growth. The time it takes for a baby to suckle with a cleft palate is often longer than that of a normal child, and it can take a lot of time and effort at first to practice breastfeeding with a specialized bottle. Therefore, the mother needs to feed the baby more often, the feeding time should be less than 15 minutes to avoid the baby being exhausted and tired from trying to suckle.
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2. Pre-operative orthopedic care
Before surgery for cleft lip and palate, the child's palate needs to be treated orthopedic in cases of cleft lip, wide palate, protruding jaw anteriorly, collapsing nose tip, deformed a lot.At this stage, the child will be taken care of by the treating doctor by making a special appliance to fit snugly in the mouth, fixed by a tight fit with the hard palate, vestibular recess and adhesive tapes both cheeks. The role of this appliance is to help the baby suckle and suck more easily, prevent the communication between the nasal cavity and the oral cavity, and minimize milk choking.
Advanced orthopedic treatments are performed depending on each child's condition in order to round the nose, straighten the nose post, prevent the tongue from entering the gap, not make the gap wider, and at the same time lengthen the short lip part. , creating maximum conditions for surgery.
The process of orthodontic correction of cleft lip and palate can be done from the time the child is 2 days old if the child is healthy, creating easy conditions for the child to be nurtured and cared for later as well as creating favorable conditions for the child to be nurtured and cared for later. good for future surgery.
At this stage, children need to pay attention to nutrition according to the following table:
3. Care for cleft lip surgery
Cleft lip surgery for children is recommended to be performed when the baby is 3-4 months old and weighs 5 kg or more. Because of the following reasons, children with cleft lip should not have early surgery:
Newborns are easily stressed due to a new environment, it takes time for them to adapt Through lip movement such as sucking milk, the amount of sphincter muscles Lips will increase and fully develop, making surgery easier Late surgery will be safe for anesthesia and monitoring after surgery Have time for orthopedic treatment before surgery, helping to restore the deformity of the nose and maxillary bone Improve the safety of surgery, 3-4 months is the right time for surgery
4. Care after cleft lip surgery
The incision is cleaned daily. Avoid impacts such as bumps and scratches on the incision. Pay attention to keep the child from touching the incision. Need immediate treatment if there is rhinitis, nosebleeds, water. nose, limit infections Eat milk by spooning, only after 2 weeks of surgery can you drink a specialized bottle. Limit sun exposure in the first year after surgery.5. Care during cleft palate surgery
For cleft palate surgery, children need to be more than 10 pounds, at the age of 18-24 months, in some cases, the doctor may appoint surgery at 12 months. For cleft palate surgery, early surgery is beneficial for children in terms of language, but late surgery is beneficial in terms of jaw bone development. Parents and doctors should work together to decide the most appropriate time for surgery.After cleft palate surgery, children should eat soft foods such as porridge, milk completely in the first 2 weeks. Children can drink boiled water to cool down after eating, gargle to clean the oral cavity. At this time, it is necessary to guide and encourage the child to blow the tube to strengthen the function of the tracheopharyngeal and pharyngeal muscles.
Children with cleft palate surgery also need to be examined and treated for language after surgery depending on the time of their development but falls around 4 months of age.
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6. Pre-school care (2-6 years old)
During this period, some problems children may face are tooth decay, crooked teeth, distorted teeth, flat mid-face, language abnormalities, psychological disorders caused by friends teasing... Parents need Coordinate with the birth doctor to help your child get through this time by:Take care of your teeth to chew well, limit dental diseases, support language development Pronunciation treatment: practice blowing pipes, visiting exams and treatment under the guidance of a linguist. Treatment of VA, otitis media. Orthodontic treatment, jaw bone: Bone dilating, pulling the maxillary bone forward, preventing hypoplasia, straightening the permanent teeth. In the school period (6-18 years old), children continue to receive dental care, orthodontic treatment of dental arches, jaw bones, alveolar bone grafts and psychological treatment if necessary.
Over 18 years old, we need surgery to correct the way of the nose, correct bad scars on the lips if any, double-jaw bone spur surgery (for cases where dental arch and jaw bone cannot be corrected), surgery jawbone dilation if the arch gap is too large.
Thus, the combined care and treatment process of children with cleft lip and palate defects should be performed continuously throughout the process from birth to adulthood to achieve the best results.
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