Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised?
A. GI function
B. Locomotion
C. Sucking ability
D. Respiratory status
Correct Answer: C. Sucking ability
Because of the defect, the child will be unable to form a mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Patients with cleft lips inherently will have some degree of alveolar cleft with potential for collapse of the maxillary arch and class III malocclusion (the maxillary teeth sit posterior to the mandibular teeth). These hard and soft tissue anatomic changes translate to the various changes in appearance, speech, and swallowing/feeding seen in cleft lip patients.
Option A: GI functioning is not compromised in the child with a CL. Speech-language therapists and nutrition consults are usually required to teach parents techniques to meet the special feeding needs of these children. When patients do not meet feeding requirements for adequate nutrition, which is most common when there is a concomitant cleft palate, feeding access is sometimes required with the assistance of the pediatric surgery team.
Option B: Locomotion would be a problem for older infants because of the use of restraints. Nurses who look after these infants should be fully aware of the risk of aspiration, airway obstruction, and difficulties with feeding. There is no single method of feeding that works in all children and the mother should be educated on the different techniques to help the infant latch on the nipple. In general, the recommendation is a soft nipple that may need to be angled.
Option D: Respiratory status may be compromised if the child is fed improperly during the postoperative period. The mother should be taught about the potential for aspiration and choking. If the infant fails to gain weight, a visit to the pediatrician is highly recommended.