THE WESTERN JOURNAL OF MEDICINE
-
FEBRUARY 1991
Feeding Children Who Have Cleft Lip
or
154
o
o
Palate
SURGEONS HAVE ASSUMED that special feeding 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 immediate breastfeeding 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 do well 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 learning capacity. 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
207
2
207~~~~~~~~~~~~
breasts after lip repair. 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 and breast-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 infants with 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 Francisco
ROGER L. GREENBERG, MD
ERic P. BACHELOR, MD
ROBERT A. HARDESTY, MD
CMA Section Chair Pleasanton
Loma Linda University
LARS M. VISTNES, MD
WILLIAM W. SHAW, MD University of California, Los Angeles JACK FISHER, MD
MICHAEL P. FALVEY, MD
Stanford University
University of California, San Diego
Westlake Village
CMA Section Secretary Torrance
THOMAS R. STEVENSON, MD
STEPHEN J. MATHES, MD
ANGELO CAPOZZI, MD
Section Editor University of California, Davis JOHN 0. STRONG, MD University of California, Irvine
University of California, San Francisco
San Francisco
JOHN REINISCH, MD University of Southern California HALE TOLLETH, MD
Medical Student University of California, Irvine
MICHAEL G. CEDARS, MD CMA Section Assistant Secretary Berkeley
San Francisco
EDWARD V. HENJYOJI, MD
SCOTT R. MILLER*
Concord
*Scott R. Miller was listed inadvertently as the medical student representative for the January Pathology Epitomes; that student was William Isenberg, PhD, of the University of
California, San Francisco.
-
FEBRUARY 1991
Feeding Children Who Have Cleft Lip
or
154
o
o
Palate
SURGEONS HAVE ASSUMED that special feeding 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 immediate breastfeeding 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 do well 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 learning capacity. 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
207
2
207~~~~~~~~~~~~
breasts after lip repair. 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 and breast-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 infants with 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 Francisco
ROGER L. GREENBERG, MD
ERic P. BACHELOR, MD
ROBERT A. HARDESTY, MD
CMA Section Chair Pleasanton
Loma Linda University
LARS M. VISTNES, MD
WILLIAM W. SHAW, MD University of California, Los Angeles JACK FISHER, MD
MICHAEL P. FALVEY, MD
Stanford University
University of California, San Diego
Westlake Village
CMA Section Secretary Torrance
THOMAS R. STEVENSON, MD
STEPHEN J. MATHES, MD
ANGELO CAPOZZI, MD
Section Editor University of California, Davis JOHN 0. STRONG, MD University of California, Irvine
University of California, San Francisco
San Francisco
JOHN REINISCH, MD University of Southern California HALE TOLLETH, MD
Medical Student University of California, Irvine
MICHAEL G. CEDARS, MD CMA Section Assistant Secretary Berkeley
San Francisco
EDWARD V. HENJYOJI, MD
SCOTT R. MILLER*
Concord
*Scott R. Miller was listed inadvertently as the medical student representative for the January Pathology Epitomes; that student was William Isenberg, PhD, of the University of
California, San Francisco.
