A cleft palate (PAL-it) happens when a baby is born with an opening (a cleft) on the roof of their mouth. This leaves a hole between the nose and the mouth.

Your baby had surgery to repair their cleft palate, which closed the opening between their nose and mouth. It will help your baby eat more easily, speak more clearly as they grow, and help prevent ear and other types of infections.

Your child had general anesthesia to let them sleep through the surgery. After the surgery, they stayed in the hospital to recover and are now ready to go home.

Your child's care team will guide you through feeding your baby and protecting the surgery area.

Here's how to care for your baby at home.

Follow your care team's instructions for:

• Giving your baby pain medicines. These may include prescription pain medicine, acetaminophen (Tylenol® or a store brand), or ibuprofen (Advil®, Motrin®, or a store brand). Some prescription pain medicines also include acetaminophen or ibuprofen. To avoid giving too much, give the medicines exactly as your care team recommends.
• When you can give your baby a bath
• Any special care of the stitches and whether they will dissolve on their own or if you need to bring your baby back to have them removed
• When to follow up

Protect the surgery area:

• If your baby was given arm splints (called “no-no's”) to prevent them from touching the surgery area:
  • Follow any special directions from the care team for when your baby needs to wear them. Usually, babies need to keep them on at all times, even during sleep.
  • To prevent skin irritation, put the arm splints on over long sleeves.
  • Check your baby's skin under the arm splints a few times a day for redness or irritation.
  • Keep the arm splints clean and dry.
  • Keep using the arm splints for as long as the care team recommends.
• Don't put any hard toys in your baby's mouth and don't use a toothbrush to brush your baby's teeth. If needed, you can clean the front teeth with a piece of gauze dipped in water.
• Don't give your baby a pacifier.
• Hold your baby facing out so they don't bump the surgery area on your shoulder or on something else.
• Avoid bouncing, rough play, or any other situations where your baby might bump their face.

Feeding your baby:

• Talk to your care team about whether you can continue to breastfeed or give your baby a bottle as usual. If you give your baby a bottle, you may need to use a certain kind of bottle and nipple.
• Your baby can drink from a regular cup. Don't use a sippy cup with a hard spout, straw, or any kind of top unless you check with your care team first.
• Try to keep your baby as upright as possible while breastfeeding, bottle feeding, or eating.
• Use a soft-tipped spoon and avoid using a fork to feed your baby. Don't let your baby feed themselves until the care team says it's OK.
• Offer soft foods such as yogurt, pudding, mashed potatoes, applesauce, and smooth purees. You can puree your baby's food by putting it in a blender until it is thin. Do not give hard, crunchy, sharp, or hot foods (such as chips, crackers, toast crusts, or hot soup).
• Offer small, frequent meals rather than large meals.
• Be sure your baby is drinking plenty of liquids. You will know they are getting enough liquids if:
  • They have a wet diaper or pee at least every 4–6 hours.
  • Their mouth is moist.
  • They have tears when they cry.
• Rinse your baby's mouth with water after every feeding to keep the stitches clean.
• Once the surgeon says it's OK to go back to your child's regular diet, work with the care team to slowly add thicker foods.

Important tips:

• If you feel like your baby isn't feeding normally because of soreness from the surgery, give the pain medicine about an hour before feedings.
• It's expected that your baby will be a little fussy for the first few days after surgery. Gentle rocking, soft music, skin-to-skin contact, and a quiet environment will all help your baby feel comforted.
• Don't pick at the stitches or surgery area.

Your baby:

• Has signs of an infection near the surgery area, such as redness, swelling, or oozing fluid
• Seems to have more pain that doesn't get better with pain medicine
• Vomits (throws up)
• Has new openings or gaps in the mouth around the surgery area
• Has bleeding from the surgery area (Hold a piece of clean gauze on the area while you call the surgeon.)
• Develops a fever

Your baby:

• Isn't drinking at all or has signs of dehydration (not enough water in the body), such as a dry or sticky mouth, sunken eyes, less pee or darker pee than usual, little or no tears when crying, or unusual sleepiness
• Has bleeding from the surgery area that doesn't stop after holding a clean piece of gauze on the area for 10 minutes (Continue to hold the gauze on the area while you call the care team.)

Will my child have a scar from the surgery? Yes, when the wound heals, there will be a small scar on the roof of the mouth. The scar usually gets better with time. Your child may still have a gap in the gum area. If needed, your child can have another surgery when they are older to help close the gap in the gums.

What kinds of problems can kids with cleft palate have after surgery? Most children do well after cleft palate surgery, but some may have problems with their teeth, a nasal-sounding voice, trouble speaking clearly, or have more ear infections than other kids. Some children may need another lip or nose surgery as they grow. Your baby's care team has many different specialists to support you and your baby.

Can my baby go to childcare? It's best to keep your baby home for at least two weeks (or longer if the care team recommends it) to prevent rough play that might injure the surgery area and help your child avoid getting sick. Talk to your surgeon about when it's safe for your baby to return to childcare.