Operations for harelip and cleft palate; the emotional complications in children.

Mothers of children who need reconstructive operations for defects present at birth are likely to feel guilty, particularly if the pregnancy was unwanted. The physician treating the child is in a position to reassure the mother and assuage her guilt. To the child, the meaning of a surgical experience depends not on the type or seriousness of the actual operation, but on the type and depth of imaginings which it stimulates. For children between two and four, the anxiety of separation from the mother is greater than that aroused by the anesthetic. A good relationship with the mother will insulate the child against many traumatic events.A surgical operation is an important and stressful experience for a child, activating the great childhood fears of abandonment, of mutilation, and of death. Very frequently, children with harelip and cleft palate, by the time definitive restorative surgery is contemplated, have had emotional experiences that make them more than usually vulnerable to the harmful effects of operation. If the child can discuss the products of his imagination about the operation and have them corrected by someone he trusts, the total response will be more adequate. Talking out and playing out help prevent the development of excessive and harmful emotional reactions.