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Experimental Treatment: Surgical repair of cleft lip in animals in utero demonstrated better healing of the lip than conventional means.

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Because of the long-term, multidisciplinary nature of services needed for the child, assist the parents in accessing appropriate support within the health care system. Support the parents before and during the surgical procedure by identifying the positive features of the newborn. Call the infant by name. Current surgical practices provide excellent repairs with minimal scarring. Encourage parents to discuss their feelings about the child's appearance. Sharing pictures of children with successful CL repairs may help the parents cope with their fears and anxieties.

Depending on the severity of the cleft, children with CL/CP will have problems sucking. Work with the parents and experiment with devices that will improve nutrition, such as different kinds of nipples. The infant may feed better if the parents use a nipple with a flange that occludes the cleft or a large, soft nipple with large holes. Try holding the infant at different positions during feeding (e.g., at a 60- to 80-degree angle). Breastfeeding can be successfully carried out as long as the mother can maintain a seal during nursing. In some nursing pairs, the breast tissue may help form the seal. Otherwise, the mother can use the hand not holding the infant or she can use a molded nipple.

Parents should be allowed to verbalize fears and anxiety about the deformity. The first time parents see their baby, they may experience shock, disappointment, or guilt. If you help them see the baby's assets, you encourage bonding and acceptance. Allow ample time for the parents to hold the infant to promote bonding. Explain the surgical procedure and postoperative care to parents.

The postoperative management of an infant with a CL focuses on protection of the operative site. Arm restraints prevent the child from rubbing the site and from self-injury. Hang baby toys within reach of the baby's restrained hands. Many infants are more comfortable in an infant seat rather than lying in a crib. In order to avoid facial contact with the sheets, do not place infants on

240 Colorectal Cancer their stomachs for sleep. Pacifiers are contraindicated, and feeding methods should be designed to reduce any tension on the suture line. Use a cotton-tipped applicator and a cleansing solution to clean the suture line. An antibiotic ointment may be prescribed. Pain should be controlled with analgesic medication and nonpharmacologic strategies such as holding and rocking.

The postoperative management of an infant with a CP centers on prevention of injury to the operative site. Do not place sharp or potentially injurious objects in the child's mouth (spoons, forks, straws, etc.). Feeding may be done from the side, but self-feeding is prohibited. After feeding, make sure to cleanse the child's mouth with water or a cleansing solution.

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