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 How Is All This Treatment Going to Be Carried Out and Where? Making the Plate Your baby will come into the British Columbia’s Children’s Hospital Day Care Surgery to have an “impression” or mould taken of the upper gums by Dr. Loo. This procedure is usually done when your baby is 7-14 days old, and most frequently performed in the hospital OR with an anesthetist “standing by;” your baby is not anesthetized. The anesthetist is present to monitor your baby and help with breathing if there is a concern; this however, is very unlikely, but we want to be as careful as possible. Our nurse practitioner or anesthetist will advise you of when your baby’s last feed must be before the procedure is to occur. From this impression, Dr. Loo will make the plate out of plastic. It will be custom-made and specially designed for your baby. The plate will be fitted at Dr. Loo’s office the next day.    Once your baby is returned to you after 15-20 minutes, you may feed him. At this stage, you will be given an appointment at our orthodontic office for the fitting of the plate. This is usually within a couple of days. The rest of the adjustment appointments will occur at our office. A plaster cast is made from the impression and then our lab technician will fabricate the appliance.  Fitting the Plate At the plate-fitting appointment, Dr. Loo will show you how to place and remove the plate. To obtain the best result, the plate should be worn 24 hours per day until the roof of the mouth is surgically repaired at 9 to 12 months. Most babies are able to wear the plate 24 hours a day right from the start and within a day or two are actually unhappy when you remove it. You will also be given instructions on how to fit the various tapes (stretchy and steristrips) and elastics.    This shows the Duoderm (plastic skin) or base tape that is fitted to the cheeks.  This is the lip tape and it must be placed very tightly enough to see the lip blanch (looks white).   At first, you may find that the plate appears loose. You can use denture adhesive to help your baby hold the plate in with the tongue. Also, do not be surprised if your baby has a slight gag reflex at first. This is perfectly normal and goes away soon after placement. Soothe your baby and hold the appliance in with the top of your thumb while rubbing the lower front gums with the bottom of your thumb.   Associating food with the plate in the first few days helps your baby get used to the plate as well. Soak the plate in formula, insert the plate and feed your baby. This provides positive reinforcement for wearing the plate. If you are looking up into your baby's mouth, these diagrams show in general the ways the taping and plates work. (Left: bilateral cleft lip and palate. Right: unilateral cleft lip and palate.)
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