For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). This will be decided by your child's surgeon. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 9 to 18 months, but before the age of 2. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child's physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.
Initial visit
At your first visit with the plastic surgeon, he/she will discuss with you the details of the surgery, risks, complications, costs, recovery time, and outcome. At this time, your child's surgeon will answer any questions you may have.
After the surgery for cleft lip
Your child may be irritable following surgery. Your child's physician may prescribe medications to help with this. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.
Stitches will either dissolve on their own or will be removed in approximately five to seven days. Specific instructions will be given to you regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.
During the surgery, and for a short time after surgery, your child will have an intravenous catheter (IV) to provide fluids until he/she is able to drink by mouth. For a day or two, your child will feel mild pain, which can be relieved with a non-aspirin pain medication. A prescription medication may also be given for use at home.
Your child's upper lip and nose will have stitches where the cleft lip was repaired. It is normal to have swelling, bruising, and blood around these stitches.
After the surgery for cleft palate
This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. Your child's physician may order pain medicine to help with this. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. An intravenous (IV) catheter will be used to help give your child fluids until he/she can drink adequately.
Your child will have stitches on the palate where the cleft was repaired. The stitches will dissolve after several days and they do not have to be taken out by the physician. In some cases, packing will be placed on the palate. Do not take the packing out unless you are told to do so by your child's physician.
There may be some bloody drainage coming from the nose and mouth that will lessen over the first day.
There will be some swelling at the surgery site, which will diminish substantially in a week.
For two to three days, your child will feel mild pain that can be relieved by a non-aspirin pain medication. A prescription medication may also be given for use at home.
Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite. Your child's physician may prescribe medication to relieve the nasal congestion.
Your child will be on antibiotics to prevent infection while in the hospital. Your child's physician may want you to continue this at home.
Your child may be in the hospital for one to three days, depending on your child's physician's recommendation.
A small amount of water should be offered after every bottle or meal to cleanse the incision. You can continue to rinse this area gently with water several times a day, if necessary.
Diet after surgery
Your child's physician may allow breastfeeding, bottle-feedings, or cup-feedings after surgery. Your child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes, and gelatin. Note: your child should not use a straw or pacifier, as both could damage the surgical repair.
Activity after surgery
Your child can walk or play calmly after surgery. He/she should not run or engage in rough play (i.e., wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery. Your child's physician will advise you when your child can safely return to regular play.
Follow-up with your child's surgeon and the cleft team is very important. This will be discussed with you. Your child's physician will also be an important part of the child's overall health management after the surgery.
Your child had surgery to repair birth defects that caused a cleft in which the lip or the roof of the mouth did not grow together normally while your child was in the womb. Your child had general anesthesia (asleep and not feeling pain) for the surgery.
After anesthesia, it is normal for children to have stuffy noses. They may need to breathe through their mouths for the first week. There will be some drainage from their mouths and noses. The drainage should go away after about 1 week.
Clean the incision (surgery wound) after feeding your child.
- Your health care provider may give you a special liquid (hydrogen peroxide) for cleaning the wound. Use a cotton swab (Q-tip) to do so. If not, clean with warm water and soap.
- Wash your hands before starting.
- Begin at the end that is closer to the nose.
- Always begin cleaning away from the incision in small circles. Do not rub right on the wound.
- If your doctor gave you an antibiotic ointment, put it on your child's incision after it is clean and dry.
Some stitches will break apart or go away on their own. The provider will need to take others out at the first follow-up visit. Do not remove your child's stitches yourself.
You will need to protect your child's incision.
- Feed your child only the way your provider told you.
- Do not give your child a pacifier.
- Babies will need to sleep in an infant seat, on their backs.
- Do not hold your child with their face toward your shoulder. They can bump their nose and harm their incision.
- Keep all hard toys away from your child.
- Use clothes that do not need to be pulled over the child's head or face.
Young infants should be eating only breast milk or formula. When feeding, hold your infant in an upright position.
Use a cup or the side of a spoon for giving your child drinks. If you use a bottle, use only the kind of bottle and nipple that your doctor has recommended.
Older infants or young children will need to have their food softened or pureed for some time after surgery so it is easy to swallow. Use a blender or food processor to prepare food for your child.
Children who are eating foods other than breast milk or formula should be sitting when they eat. Feed them only with a spoon. Do not use forks, straws, chopsticks, or other utensils that can harm their incisions.
There are many good food choices for your child after surgery. Always make sure the food is cooked until it is soft, then pureed. Good food options include:
- Cooked meats, fish, or chicken. Blend with broth, water, or milk.
- Mashed tofu or mashed potatoes. Make sure they are smooth and thinner than normal.
- Yogurt, pudding, or gelatin.
- Small curd cottage cheese.
- Formula or milk.
- Creamy soups.
- Cooked cereals and baby foods.
Foods your child should not eat include:
- Seeds, nuts, bits of candy, chocolate chips, or granola (not plain, nor mixed into other foods)
- Gum, jelly beans, hard candy, or suckers
- Chunks of meat, fish, chicken, sausage, hot dogs, hard cooked eggs, fried vegetables, lettuce, fresh fruit, or solid pieces of canned fruit or vegetables
- Peanut butter (not creamy or chunky)
- Toasted bread, bagels, pastries, dry cereal, popcorn, pretzels, crackers, potato chips, cookies, or any other crunchy foods
Your child may play quietly. Avoid running and jumping until the provider says it is OK.
Your child may go home with arm cuffs or splints. These will keep your baby from rubbing or scratching the incision. Your child will need to wear the cuffs most of the time for about 2 weeks. Put on the cuffs over a long-sleeve shirt. Tape them to the shirt to keep them in place if needed.
- You may take the cuffs off 2 or 3 times a day. Take off only 1 at a time.
- Move your child's arms and hands around, always holding on and keeping them from touching the incision.
- Make sure there is no red skin or sores on your child's arms where the cuffs are placed.
- Your child's provider will tell you when you can stop using the cuffs.
Ask your provider when it is safe to go swimming. Children may have ear tubes and if so you will need to keep water out of their ears.
Your provider will refer your child to a speech therapist. The provider may also make a referral to a dietician. Most times, speech therapy lasts 2 months. You will be told when to make a follow-up appointment.
Call your provider if:
- Any part of the incision is opening or stitches come apart.
- The incision is red, or there is drainage.
- There is any significant bleeding from the incision, mouth, or nose. If bleeding does not stop with gentle pressure, go to the emergency room or call 911 or the local emergency number.
- Your child is not able to drink any liquids.
- Your child has a fever of 101°F (38.3°C) or higher.
- Your child has a fever that does not go away after 2 or 3 days.
- Your child has problems breathing.
Orofacial cleft - discharge; Craniofacial birth defect repair - discharge; Cheiloplasty - discharge; Cleft rhinoplasty - discharge; Palatoplasty - discharge; Tip rhinoplasty - discharge
Costello BJ, Ruiz RL. Comprehensive management of facial clefts. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery. 3rd ed. St Louis, MO: Elsevier; 2018:chap 28.
Shaye D, Liu CC, Tollefson TT. Cleft lip and palate: an evidence-based review. Facial Plast Surg Clin North Am. 2015;23(3):357-372. PMID: 26208773 pubmed.ncbi.nlm.nih.gov/26208773/.
Wang TD, Milczuk HA. Cleft lip and palate. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 188.
Updated by: Tang Ho, MD, Associate Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.