Prior to the cleft palate repair, your infant must be off a bottle and pacifier and only drinking from a cup. We will schedule a special visit before your child’s surgery to help you learn how to transition them to cup feeding. You may need to wean your baby off of a bottle as early as 6 months of age.

This timeline provides you with a general treatment plan overview.  

Birth-2 months
Your baby will see a plastic surgeon in their first month. If your baby needs a special appliance to help them eat, they will also need to see a pediatric dentist.

At this visit, the team will:

• Ask questions about your family history and your pregnancy
• Weigh your baby
• Take photos of your baby
• Review the best treatment plan for your baby 
• The dentist will make a model of your baby’s gumline to create a dentomaxillary appliance (this looks like a retainer)

Between 6 weeks to 2 months of age, surgery is done to insert the appliance in their mouth

• Surgery is done with general anesthesia (sleepy medicine) and your baby will stay overnight in the hospital

6 months
It is time to get your baby ready for their cleft palate repair. Your child will not be able to drink from a sippy cup after the cleft palate repair as it may irritate the stitches.

9 months
The cleft palate is repaired by closing the gap in the palate. The exact surgical technique depends on the type and severity of your child’s cleft palate.

• Ear (PE) tubes  are inserted during surgery.
• If your baby needs further repair of a cleft lip, it is also done at this time.

3-5 years old
When your child begins to speak in sentences, a speech pathologist will evaluate their speech.  Speech therapy and/or surgery may be needed.

• If surgery is needed, your child will see a plastic surgeon that will perform pharyngeal flap surgery.

5-9 years old
If your child’s cleft goes through the gumline, they may need to have this area expanded in preparation for a bone graft. 

• The pediatric dentist or orthodontist does the expansion in the office,

The bone graft is done in the hospital and bone is taken from the hip for this graft.

11-20 years old
Braces (orthodontics) are usually started around this age. As your child’s face changes, other revisions of the lip and/or nose may be desired. 

• For some of the procedures, it is necessary to wait until your child is finished growing.

  • Jaw surgery to bring the upper jaw forward and/or the lower jaw back
  • Septorhinoplasty – to straighten and refine the nose
  • Malar implants – to build up the mid-face (cheekbones), revision of the lip and nose

You will need to protect your child’s palate from injury while it is healing. It is hard to tell how much feeling your child has in the repaired palate. The tissue may be numb and without feeling for a period of time after surgery. If this is the case, it is possible for your child to injure the roof of their mouth without feeling any pain. Special treatment is unnecessary,  but you must watch them closely to keep hands and objects out of their mouth.

Your baby will have elbow restraints for one to two weeks after surgery (physician dependent) to keep hands away from the surgical site. Remove the restraints to exercise the arms. Remove one restraint at a time, on a rotating basis, every hour or so to exercise and massage the arms. Make sure to watch your child closely when the elbow restraint is off.

• The child refuses to eat or has a decrease in wet diapers
• The child has a fever over 100.4°
• You have any questions or concerns