Nurse Karen is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following?
A. In an infant seat
B. In the supine position
C. In the prone position
D. On his side
Correct Answer: C. In the prone position
Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach. It is important to keep the stitches clean and without crusting.
Option A: Using an infant seat does not facilitate drainage. It is important to keep the child from hurting the incision or putting hands or toys in their mouth. For this reason, they will wear arm restraints (NoNo’s) which keep them from bending their elbows. These are also used for 10 days after surgery.
Option B: If the child is placed in the supine position, aspiration is a concern. There may be some discomfort as the child swallows so they may not drink much the first evening. This is why IV fluids are continued until their drinking improves. Pain medicine will also be given to relieve distress.
Option D: Side-lying does not facilitate drainage as well as the prone position. The goal after surgery is to protect the new repair and stitches. For this reason, there will be some changes in the child’s feeding, positioning, and activity for a short time.