# Cleft lip, Failure to thrive, Autism, ADHD

The parents of an infant with a cleft palate ask the nurse, "What follow-up care will our infant need after the repair?" Which is an accurate response by the nurse?
a. "Your infant will not need any subsequent follow-up care."
b. "Your infant will only need to be evaluated by an audiologist."
c. "Your infant will only need follow-up with a speech pathologist."
d. "Your infant will need follow-up with audiologists and orthodontists."
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The parents of an infant with a cleft palate ask the nurse, "What follow-up care will our infant need after the repair?" Which is an accurate response by the nurse?
a. "Your infant will not need any subsequent follow-up care."
b. "Your infant will only need to be evaluated by an audiologist."
c. "Your infant will only need follow-up with a speech pathologist."
d. "Your infant will need follow-up with audiologists and orthodontists."
ANS: D
A cleft palate means that audiologists will evaluate the child's hearing throughout early childhood and work closely with otolaryngologists to determine if pressure-equalizing (PE) tubes are needed. An infant with a cleft palate will also go through multiple phases of orthodontic intervention to align the teeth and the maxillary arches. Follow-up will be needed as the child grows. Following up with only an audiologist or only a speech pathologist would not be adequate.
A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action?
a. Encourage the mother to express her feelings.
b. Explain in simple language that the baby has a cleft lip.
c. Provide emotional support until the practitioner can talk to the mother.
d. Tell the mother a pediatrician will talk to her as soon as the baby is examined.
ANS: B
It is best to explain in simple terms the nature of the defect and to reinforce and help clarify information given by the practitioner before the newborn is shown to the parents. Parents may not be ready to talk about their feelings during the first few days after birth. The nurse should provide information about the child's condition while waiting for the practitioner to speak with the family after the examination. The mother needs simple explanations of her child's condition during this period of waiting.
An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which?
a. Initiating discharge teaching
b. Performing baseline physical and behavioral assessment
c. Observing for allergic reactions to preoperative antibiotics
d. Determining whether this defect exists in other family members
ANS: B
It is essential to assess the infant before surgery to obtain a baseline. Postoperative changes can be identified and a determination can be made regarding pain or change in status. The parents are not ready for discharge teaching. Their focus is on the congenital defect and surgery. Although a remote possibility, allergic reactions rarely occur on the first dose. Determining whether this defect exists in other family members is an important part of the history but is not a priority before surgery.
A 4-month-old infant is discharged home after surgery for the repair of a cleft lip. What should instructions to the parents include?
a. Provide crib toys for distraction.
b. Breast- or bottle-feeding can begin immediately.
c. Give pain medication to the infant to minimize crying.
d. Leave the infant in the crib at all times to prevent suture strain.
ANS: C
Pain medication and comfort measures are used to minimize infant crying. Interventions are implemented to minimize stress on the suture line. Although crib toys are important, the child should not be left in the crib for prolonged periods. Feeding begins with alternative feeding devices. Sucking puts stress on the suture line in the immediate postoperative period. The infant should not be left in the crib but should be removed for appropriate holding and stimulation.
ANS: A, B, D
A bottle-fed infant with an isolated cleft lip should be fed with cheek support (squeezing the cheeks together to decrease the width of the cleft), which may help the infant achieve an adequate anterior lip seal during feeding. Systems that have a wider base, such as an NUK (orthodontic) nipple or a Playtex nurser, allow the infant with a cleft lip to feed more successfully. The infant should be positioned upright with the head supported. This position helps gravity to direct the flow of liquid so that it is swallowed rather than entering into the nasal cavity. Enlarging the nipple opening would allow too much milk too fast for an infant with a cleft palate. Thickening the formula with rice cereal is done for infants with gastroesophageal reflux, not cleft lip.
ANS: A
One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.
Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake?
a. Vary the schedule for routine activities on a daily basis.
b. Be persistent through 10 to 15 minutes of food refusal.
c. Avoid solids until after the bottle is well accepted.
d. Use developmental stimulation by a specialist during feedings.
ANS: B
Calm perseverance through 10 to 15 minutes of food refusal will eventually diminish negative behavior. Children with FTT need a structured routine to help establish rhythmicity in their activities of daily living. Many children with FTT are fed exclusively from a bottle. Solids should be fed first. Stimulation is reduced during mealtimes to maintain the focus on eating.
An infant has been diagnosed with failure to thrive (FTT) classified according to the pathophysiology of inadequate caloric intake. The nurse understands that the reason for the FTT is most likely related to what?
a. Cow's milk allergy
b. Congenital heart disease
c. Metabolic storage disease
d. Incorrect formula preparation
ANS: D
FTT classified according to the pathophysiology of inadequate caloric intake is related to incorrect formula preparation, neglect, food fads, excessive juice poverty, breastfeeding problems, behavioral problems affecting eating, parental restriction of caloric intake, or central nervous system problems affecting intake consumption. Cow's milk allergy would be related to the pathophysiology of inadequate absorption, congenital heart disease would be related to the pathophysiology of increased metabolism, and metabolic storage disease is related to defective utilization.