Cleft Lip and Palate

Cleft lip and palate are openings
or splits in the upper lip or roof of the mouth (palate). A child can be born with
a
cleft lip, cleft palate, or both. Cleft lip and palate may be the only birth defects,
or
they may happen with other defects.

A cleft lip may be as mild as a
notch of the lip. Or it may be as severe as a large opening from the lip to the
nose. 

A cleft palate may leave an opening
that goes into the nasal cavity. Cleft palate is not as noticeable as cleft lip because
it is inside the mouth. The cleft may:

  • Involve one or both sides of the
    palate
  • Go from the front of the mouth or hard
    palate to the throat or soft palate
  • Include the lip

Cleft lip and cleft palate happen
when a baby develops in the womb. Researchers don’t know the exact cause of cleft
lip
and palate. It can be caused by genes passed on from parents, as well as environmental
factors. Environmental factors include taking certain medicines during pregnancy,
smoking or drinking alcohol during pregnancy, infections, and too little vitamin B
and
folic acid during pregnancy. Parents who have cleft lip, cleft palate, or both, or
who
have other kids with the problem are at an increased risk of having babies with the
defect.

The symptoms of these problems can
be seen during the first exam by your baby’s healthcare provider. How much the lip
or
palate differs from normal can vary. The symptoms can include:

  • Lip does not close fully
  • Roof of the mouth does not close
    fully
  • Neither the lip nor the roof of the
    mouth closes fully

A cleft lip and cleft palate can be diagnosed during pregnancy during
a routine ultrasound exam. Or they may be seen during the first exam by your baby’s
healthcare provider.

Both cleft lip and cleft palate can
be fixed with surgery.

  • Cleft
    lip.
    The first surgery for cleft lip is usually done before a baby is 1 year
    old, but as early as possible.
  • Cleft palate. The first
    surgery for cleft palate is usually done within the first 18 months after birth, but
    again as early as possible.

Beyond the appearance of a cleft
lip, other possible complications include:

  • Feeding trouble. Feeding trouble happens more with
    cleft palate defects. Your baby may not be able to
    suck properly because the roof of the mouth is not formed completely. Most babies
    with cleft palate are not able to breastfeed. But they can be fed breastmilk with
    special nipples and bottles.
  • Ear infections and hearing loss. Ear infections are often
    caused by problems with the tubes that connect the middle ear to the throat
    (eustachian tubes). Infections that come back again and again can then lead to
    hearing loss.
  • Speech and language delay. Muscles involved with speech
    may not work well. This can lead to a delay in speech or odd speech. Talk with your
    child’s healthcare provider about seeing a speech therapist.
  • Dental problems. The child may have problems with his or
    her teeth. Your child may need to see an orthodontist. This is a dentist with special
    training to treat teeth that are out of line and problems with the jaw.

Cleft lip and cleft palate can’t
always be prevented. But there are things you can do to reduce the risk. They
include:

  • Get a pre-pregnancy exam to make sure
    you are healthy before you get pregnant.
  • Get regular and complete prenatal care
    during pregnancy.
  • Take folic acid if you are trying to
    get pregnant.
  • Take daily prenatal vitamins that
    include folic acid during pregnancy.
  • Don’t smoke.
  • Don’t drink alcohol during
    pregnancy.

Consider genetic counseling if
other members of your family have had cleft lip and palate.

Your baby’s healthcare provider
will help you figure out how to best care for your baby. 

The main concern for your baby is
good nutrition. Sucking is difficult because of the opening in the formed roof of
the
mouth.

A baby with a cleft lip, a cleft
palate, or both will have specific healthcare needs. What works for one child may
not
work for another.

Cleft lip

A baby with just a cleft lip
usually does not have trouble feeding. To help with feeding, try the following:

  • Breastfeed if you can. It will take
    extra time and patience. You may also pump your breastmilk and feed it to your
    baby.
  • Hold your baby in an upright
    position to help him or her swallow and to keep milk from going into the
    nose.
  • Give feedings often, but keep them
    small. This can help your baby get more calories and gain weight.
  • Try different types of bottles and
    nipples to find ones that work for your child. Many types are available for babies
    with a cleft lip. Talk with your child’s healthcare provider about which type is
    best for your child.

Cleft palate

A baby with a cleft palate will
need extra support with feeding. Talk with your child’s healthcare provider to find
out the best way to feed your baby.

  • Give breastmilk if you can. Regardless of how severe the
    cleft is, your baby will need extra support with feeding. Although most
    babies with cleft palate can’t breastfeed, some babies with a small or
    narrow cleft of only the soft palate may be able to breastfeed. Babies with
    more severe clefts are not able to breastfeed. A lactation specialist can
    teach you how to pump your breastmilk to give to your baby by bottle. Many
    types of special bottles and nipples are available for a baby with cleft
    palate. Your child’s healthcare provider or a cleft nurse feeding specialist
    can teach you how to bottle feed your child.

To help with feeding, try the
following:

  • Hold your baby in an upright position to help him or her
    swallow and to keep milk from going into the nose.
  • Give feedings often, but keep them small. This can help
    your baby get more calories and gain weight.
  • Talk with your child’s healthcare provider or a cleft
    nurse feeding specialist about the best and safest positions to offer your
    child a breast or bottle.

The team approach is used for managing and fixing cleft lip and palate. Many
healthcare providers may be involved in your baby’s care. They may include:

  • Plastic surgeon
  • Face and head (craniofacial)
    surgeon
  • Ear, nose, and throat (ENT)
    specialist
  • Orthodontist
  • Pediatric dentist
  • Speech and language therapist
  • Genetic counselor

The healthcare team may also refer your child to other specialists
unique to your child’s condition.

Cleft lip is a split in the lip,
and cleft palate is a split in the roof of the mouth.

  • Cleft lip and cleft palate happen when
    there is a problem during fetal development.
  • Genes and the environment are
    involved, but the cause is not completely understood.
  • Surgery is the treatment for both
    cleft lip and palate.
  • The main concern for a baby with cleft
    palate is good nutrition. Talk with your child’s healthcare provider or a cleft nurse
    feeding specialist.

Tips to help you get the most from
a visit to your child’s healthcare provider:

  • Know the reason for the visit and what
    you want to happen.
  • Before your visit, write down
    questions you want answered.
  • At the visit, write down the name of a
    new diagnosis, and any new medicines, treatments, or tests. Also write down any new
    instructions your provider gives you for your child.
  • Know why a new medicine or treatment
    is prescribed and how it will help your child. Also know what the side effects
    are.
  • Ask if your child’s condition can be
    treated in other ways.
  • Know why a test or procedure is
    recommended and what the results could mean.
  • Know what to expect if your child does
    not take the medicine or have the test or procedure.
  • If your child has a follow-up
    appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s
    provider after office hours. This is important if your child becomes ill and you have
    questions or need advice.