Case Study 20: The Digestive and Urinary Systems
Marissa, a newborn with a cleft lip and palate, is the third child of Juan and Maria. Both Juan and Maria are “visually alarmed” at Marissa’s appearance; however, Juan is more distant and reserved. Maria is very concerned with Marissa’s wellbeing and future and seems to take blame for Marissa’s physical condition. 2)
The incidence of cleft lip (CL) with or without cleft palate (CP) is approximately 1 in 800 live births. The incidence of CP alone is 1 in 2000 live births. CL with or without CP is more common in males, and CP alone is more common in females. The defect appears more often in Asians and certain tribes of Native Americans than in whites and less frequently in blacks. History shows that heredity plays a role in the occurrence of cleft lip and palate deformities. There is a 40% increase of clefting in siblings of a child with a cleft lip or palate. Parental age also seems to be a contributing factor; the risk of having an infant with a cleft lip or palate deformity increases in parents older than age 30. Certain medications, such as phenytoin sodium, have been shown to increase the incidence of cleft lip and palate. Maternal smoking in the first trimester is believed to be the cause of 11-12% of all cases of CL and/or CP. 3)
No, the response seen in Marissa’s parents is not unusual. The birth of an infant is an exciting and stressful event, even when the pregnancy, labor, and delivery go well. For the parents of an infant born with a facial anomaly, however, it can be a devastating experience. Facial clefting is one of the most common birth deformities. Feelings of fear, guilt, resentment, inadequacy, shame, and grief are common among parents and family members of babies born with cleft deformities. 4)
The nurse can therapeutically respond by stating, “A cleft palate is usually closed within the first year of life so that the child's speech normally develops. Sometimes a prosthetic device is...
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