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:

• Affect 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 mother’s uterus. 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 getting 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 doesn’t close fully
• Roof of the mouth doesn’t 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 often done before a baby is 1 year
  old, but as early as possible.
• Cleft palate. The first
  surgery for cleft palate is often done in 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 correctly because the roof of the
  mouth is not formed completely. Most babies with cleft palate aren’t 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 their
  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.

Think about getting 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 poorly 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
often doesn’t 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 them 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. Most babies with
  cleft palate can’t breastfeed. But some babies with a small or narrow cleft of
  only the soft palate may be able to breastfeed. Babies with more severe clefts
  can’t 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 them 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 doctor (ENT
  or otolaryngologist)
• 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 as the baby develops in the mother’s uterus.
• 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.