Labio Leporino

THE WESTERN JOURNAL OF MEDICINE

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FEBRUARY 1991

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154

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207~~~~~~~~~~~~

207

Feeding Children Who Have Cleft Lip

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Palate

SURGEONS HAVE ASSUMED that specialfeeding precautions should be adopted for children born with a cleft lip or palate or after the repair of these anomalies. Mothers in developing nations, however, consistently prove that immediatebreastfeeding is safe. Plastic surgeons should consider advising the use of the breast or conventional bottle and nipple combinations. Most children with clefts, even those with enormous tissue gaps, will dowell at breast or bottle. Only a few will require special attention or special devices. Those few will require intensive and continuing attention because nutritional deficits impair future learningcapacity. What about feeding policy immediately after surgical repair? Comparative studies show no greater rate of complication if an infant is returned immediately to mother's

breasts after liprepair. There is no evidence that a short, soft nipple or a carefully directed tip of a spoon will cause palatal dehiscence. Perhaps the greatest mechanical hazard after a lip or palate procedure,especially the latter, is a child's finger directed into the mouth. Elbow restraints are therefore critical for a week after lip repair and two weeks after palatal repair.
JACK C. FISHER, MD San Diego,California

REFERENCES
Clarren SK, Anderson B, Wolf LS: Feeding children with cleft lip, cleft palate, or cleft lip and palate. Cleft Palate J 1987; 24:244-249 Fisher JC: Discussion-Early repair andbreast-feeding for infants with cleft lip. Plast Reconstr Surg 1987; 79:886-887 Weatherley-White RC, Kuehn DP, Mirrett P, Gilman JI, Weatherley-White CC: Early repair and breast-feeding for infantswith cleft lip. Plast Reconstr Surg 1987; 79:879-885

ADVISORY PANEL TO THE SECTION ON PLASTIC SURGERY
ROGER P. FRIEDENTHAL,
MD

Advisory Panel Chair CMA Scientific Board Representative San...