Cleft Palate Repair: Instructions After Surgery

Treating Cleft Palate

The Cleft Lip and Palate Center expertly cares for children with cleft palate.

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The roof of your child’s mouth (the palate) is still healing and should be protected from injury for about 3 weeks after surgery. There may be less feeling in this area for a while after the surgery. This means that your child can injure the roof of the mouth without you or your child knowing it.

Put hard objects away, or keep them out of your child’s reach while the palate is healing. Please discuss with your surgeon the use of a pacifier after surgery. Listed below are objects that could hurt your child’s mouth.

• Small wooden, metal or plastic toys
• Popsicles and their sticks
• Toys with small parts
• Drinking straws
• Toothbrushes
• Suckers and lollipops
• Knives, forks and spoons
• Thermometers

Mouth Care

• To clean your child's teeth and gums, use a gauze pad dipped in plain water or a small amount of alcohol-free mouthwash mixed with water. Wipe the front of the teeth only.
• Do not use a toothbrush in your child’s mouth for 3 weeks.
• Have your child drink water after eating to keep the mouth clean.

Drinking and Eating

During this time, it is most important to make sure that your child is drinking enough liquids to stay hydrated. You will know if your child gets enough fluids if they have the same number of wet diapers after surgery as before. Your child should have a wet diaper at least every 8 hours. If there are fewer wet diapers, call the Cleft Lip and Palate Center helpline. This may be a sign of dehydration. You can reach the helpline at (614) 722-6299, Monday through Friday, 8 a.m. to 4:30 p.m. During evenings, weekends and holidays please call (614) 722-2000 and ask for the plastic surgeon on call.

For a short while after surgery, your child may not eat as well as before surgery.

• Give soft, pureed or mashed foods for 3 weeks. There is a table on the last page that shows specific soft foods that are and are not allowed.
• Do not give foods that have chunks, lumps or pieces, such as seeds, grains, pulp or skin.
• Do not give hard, crunchy foods such as cold cereal, cookies, crackers or chips.
• Use only a spoon for feeding.
• Do not let your child feed themself.
• Make sure the food is not too hot.
• Your child may drink from a bottle, open cup or sippy cup with a soft spout right after surgery.
• You may continue to feed your child with the same bottle system used before surgery.For more information on the types of bottles to use, see Helping Hand HH-I-21, Cleft Palate: Feeding Your Baby.

Arm Splints

Your child may or may not need to wear arm splints for 3 weeks. Please discuss this with your surgeon. These splints keep your child from putting their fingers into the mouth and accidentally damaging the repair. Before your child leaves the hospital, be sure a nurse shows you how to put the splints on properly. To find out more, refer to Helping Hand HH-II-16, Arm Restraints.

Activity or Play

• Your child may play as usual but needs to be watched more carefully during the first few weeks after surgery.
• Do not let other children give your child things to play with or eat without your approval.
• Soft toys are best for your child to play with while the palate is healing.

Pain and Medicines

It is important for your child to take medicines as directed by the doctor. Your child will go home with an antibiotic. The antibiotic needs to be taken until all of it is gone.

Some pain is normal after palate repair. Your surgeon and medical team will work together to achieve the best pain control possible, but your child may still experience discomfort. For pain, your child may be prescribed a medicine called either Oxycodone or Lortab.  Your child may also be given over-the-counter pain medicines such as Tylenol^® (acetaminophen), or Motrin or Advil (ibuprofen) instead of Oxycodone or Lortab. After a few days, your child will only need over-the-counter pain medicine.

Pain Medicines

	Prescription Narcotic Medicine	Over-the-Counter Medicine
Medicine	Lortab (Hydrocodone/Acetaminophen) or Oxycodone	Tylenol (Acetaminophen)	Motrin or Advil (Ibuprofen)
How often to take	Lortab or Tylenol - may give every 6 hours as needed		May give every 6 hours as needed

Things to Know About Side Effects for Oxycodone and Lortab

• Can be taken every 6 hours
• Has a side effect of constipation. If your child becomes constipated this may add to their pain and make it hard to tell why the child is uncomfortable.
• As soon as possible, switch from using Oxycodone or Lortab to Tylenol alone

Things to Know About Lortab

• Contains both the narcotic hydrocodone and Tylenol
• Should NOT be taken within 6 hours of any other medicines that contains Tylenol (such as Triaminic, certain cold and cough medicines)

Things to Know About Over-the-Counter Pain Medicines

• Either Motrin or Advil (ibuprofen) and Tylenol (acetaminophen) can be used.
• You can give one dose of one kind of medicine every 6 hours. Do not give two kinds of pain medicine at the same time (Picture 3).
• If using both Motrin and Tylenol, you must alternate the dose of each type of medicine. Give one kind of medicine first, then 3 hours later, give the second kind of medicine. For example, start with one dose of Motrin at 9 a.m.; 3 hours later at noon, give the dose of Tylenol. At 3 p.m., give Motrin again. At 6 p.m., give Tylenol (Picture 3).
• Do NOT give Tylenol within 6 hours of any other medicine that contains Tylenol (Lortab, Triaminic, cough and cold medicines).
• Use a pediatric measuring device (available at the pharmacy) to measure the exact dose. Do not measure liquid medicines in kitchen spoons.

What to Expect After Surgery

For the first few days after surgery, you may see the following things: 

• There may be a small amount of blood in the mucous or saliva (spit) for several days. The mucous or saliva may appear pink.
• More clear drainage (mucous) than usual may come from the nose for several weeks. This is because the opening between the nose and mouth is now closed. Before surgery, mucous drained directly into the mouth.
• Your child may snore and sound congested for several weeks. This will go away when the swelling goes down and there is less drainage. 
• It may be harder for your child to sleep as well as before surgery. Sleep habits should return to normal after several weeks.

More Tips

• Dress your child in shirts that either button down or can be zipped so you do not need to lift the shirt over the head and face.
• Your child should wear long-sleeved shirts under the arm splints. The sleeves will help the splints to stay in place and prevent skin irritation.

When to Call the Doctor

Call your child’s doctor or the Cleft Lip and Palate Center’s helpline if your child has:

• Fever over 101°F when taken rectally, axillary (under the arm) or in the ear.
• Pain that does not go away when you give pain medicine.
• Any injury to the incision or any bleeding in the mouth.
• Trouble drinking or eating.
• A dry diaper for 8 hours or more.
• Taken too much medicine or the wrong medicine. Call the Central Ohio Poison Center at (800) 222-1222, TTY (866) 688-0088. They will tell you what to do.

The Cleft Lip and Palate Center Helpline

During regular business hours from 8 a.m. to 5 p.m., Monday to Friday, call (614) 722-6299.

After hours, on weekends or holidays, call (614) 722-2000. Ask to speak with the plastic surgeon on call.

Follow-Up Appointments    

For follow-up appointments at the Cleft Lip and Palate Center, call (614) 722-6537.

• 2 weeks____________________________________
• 3 weeks____________________________________

Feeding Guidelines After Palate Surgery

Food Groups	Foods Allowed	Foods to Avoid
Meats and Other Protein	Pureed meats Pureed or fork-mashed lentils or beans (without skins) Cottage cheese Soft cheeses (American cheese square, feta) Yogurt Eggs (very well scrambled) Hummus Fork-mashed tofu	Hard cheeses (Swiss, Cheddar) Bacon Nuts or seeds Steak
Breads	Soft white bread without crust (torn into pieces) Soft pancake (torn into pieces)	Hard or crunchy breads Breads with nuts or seeds Waffles
Cereals	Cream of wheat Cream of rice Farina Infant oatmeal Grits	Hard or crunchy cereals "Cold" cereals (Cheerios, Old- fashioned or instant oatmeal)
Fruits	Fork-mashed, pureed, canned or well-cooked fruit Fork-mashed fresh bananas Smooth applesauce Stage 1 or 2 baby fruits	Hard or crunchy fruit Fruits with seeds or skin (berries, kiwis, grapes, etc.)
Vegetables	Fork-mashed, pureed, canned or well-cooked vegetables Stage 1 or 2 baby vegetables	Hard or crunchy vegetables Vegetables with seeds, pulp or skins (tomatoes, green beans, peas, corn, etc.)
Potatoes and Starches	Mashed white or sweet potatoes with no lumps, strings or skins Fork-mashed, well-cooked noodles (pasta, mac & cheese)	Hard or crunchy toppings on potatoes or noodles Sauces with chunks Rice Whole grains such as barley, quinoa, kasha, buckwheat
Desserts	Pudding Jell-O Ice cream or frozen yogurt without toppings Milkshakes	Any of the listed desserts with pieces of fruit, nuts, seeds or hard toppings Popsicles with sticks
Beverages	Formula or milk Water Juice	Pulp Chunks Lumps
Utensils	Sippy cups with short, soft spouts Bottles with a soft nipple Spoons may only be put at the lips by parent or guardian	Straws Sippy cups with long, hard spouts Spoon or fork put in the mouth
Miscellaneous	Seedless jams	Honey, agave or syrup Seeded jams Candy

Cleft Palate Repair: Instructions After Surgery (PDF), Spanish (PDF), Nepali (PDF)

HH-I-18 1/79, Revised 12/19 Copyright 1979, Nationwide Children’s Hospital