You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Special Day Care Considerations

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SPECIAL DAY CARE CONSIDERATIONS

by Carol Edson RN

Most mothers work outside the home. It is a fact of life. Most of those cannot contemplate a major change in plans after the birth of a child with an anomaly. Family finances often dictate that there must be two incomes (also, sometimes a change in employment status would mean a devastating change in insurance coverage!) For many families, day care is a necessary part of their lives. But how does one prepare the daycare provider for the special needs of the cleft infant and young child?

Children with clefts have a few special considerations that should be clear to anyone who is providing care for them. When you take your child to daycare, the following are some guidelines to help insure successful communication and prevent potential problems:

BEFORE THE PALATE IS REPAIRED:

1) Demonstrate the feeding and burping techniques that work best for your child. Have the care provider give you a demonstration in return. Offer encouragement and suggestions if needed.

2) If possible, leave the child for short stays several times before leaving him for a full day.

3) Be sure you are reachable by phone or beeper, and be sure that the provider knows how to access the beeper.

AFTER THE PALATE IS REPAIRED:

1) Do not return the child to care until cleared by the surgeon to do so. This could be several weeks!

2) Tell the provider to prevent the child from walking or playing with any toys in her mouth. A fall or bump during after care could damage the repair.

BEFORE THE LIP REPAIR:

Some children are harder to feed than others. Please weigh carefully the risks and benefits of leaving your child in another's care. Perhaps a nurse friend or someone else experienced in feeding your child can care for him for you. Since most repairs are done early, it may be possible to do it while still on parental leave for the birth or adoption.

AFTER THE LIP REPAIR:

Plan to stay home with the baby until the repair is healed. Your surgeon will guide you on this. There is no safe way to have a baby with a fresh lip repair loose with other young children (with our own daughter, we used the back pack a great deal, held her a lot, and were very careful about how she was positioned when she slept.) The danger of disruption of the suture line and/or infection means that constant parental vigilance will be necessary for those few weeks.

GENERAL CONSIDERATIONS:

Being a daycare provider myself (as well as an RN and the parent of a child with a cleft), I am a realist about sniffles. Kids in group care settings average 6 - 9 colds per year. Since even a seemingly innocuous drippy nose can be the forerunner of ear trouble for many of these kids, ask your provider to tell you if your child develops a cough or runny nose while at daycare. Give your provider a list of symptoms your child tends to exhibit when ill with an ear infection. Although some kids show no outward signs, many have a fever, are irritable, listless, pull at the ear or won't eat.

Once diagnosed your child may need medications, including decongestants and antibiotics. Write the instructions down, and bring your care giver an oral syringe, as well as the medicine, to insure accurate dosing. Have them write down what they gave the child and the time they gave it so you can keep to an appropriate schedule. Many antibiotics must be refrigerated, so be sure your care provider knows this (And write yourself a note so you won't forget to retrieve the medicine from her fridge!) Also, if possible, ask you doctor if he can prescribe one of the newer antibiotics that only have to be given twice a day.

If any child in the daycare has a communicable disease, all parents should be told. Strep throat requires 48 hours of antibiotic therapy before the child should return to care. Some areas have special sick care facilities staffed by pediatric nurses; you may want to preregister your child for future needs.

Food is an issue for some cleft palate kids, even after the repair. Many eat remarkably well and tolerate a variety of textures and tastes. Some, especially those with a very short palate, may choke easily. Give your provider a list of foods not tolerated, and explain what works best for your child.

In most respects, our kids just need the same tender, loving care that all children need. I hope that these guidelines will help you have a satisfying and safe experience with your daycare provider. Open communication is the key!

--------------Carol Edson is the Nurse Consultant for WIDE SMILES Magazine.


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