10947 Cleft Lip Cleft Palate

Overview

A cleft lip is a split in the upper lip. A cleft palate is a split in the roof of the mouth. These happen while a baby is developing in the womb, before birth. The split can be on one side or both sides and can be small or large.

About 1 in every 700 babies is born with a cleft lip and/or cleft palate worldwide.

It affects babies of all backgrounds. Cleft lip with or without cleft palate is more common in boys, while cleft palate alone is more common in girls.

Symptoms

Common symptoms

• A visible split in the upper lip or a gap in the roof of the mouth
• Difficulty feeding or milk coming out through the nose
• A nasal-sounding voice or delayed speech development

Symptoms in children

• Repeated ear infections
• Hearing problems
• Dental issues such as missing, misshapen, or extra teeth

Symptoms in older adults

• Adults who have had a cleft may have long-term speech or dental concerns
• Some may have ongoing hearing problems
• Some may feel self-conscious about their appearance, but many have had successful treatments

Causes

Main causes

• The exact cause is usually unknown
• It happens when parts of the lip or palate do not join together correctly in early pregnancy
• It may involve a combination of genes and environmental factors

Risk factors

• A family history of cleft lip or cleft palate
• Smoking during pregnancy
• Diabetes that is not well controlled during pregnancy
• Taking certain medicines for seizures during pregnancy
• Not getting enough folic acid before and during early pregnancy

When to see a doctor

See a doctor urgently if:

• If your baby has trouble breathing or feeding, see a doctor or go to the emergency department the same day
• If your baby shows signs of dehydration, seek urgent care
• If there is heavy bleeding or signs of infection after cleft surgery, get medical help right away

Book a routine appointment if:

• If you are pregnant and an ultrasound shows a cleft, talk to your care team about next steps
• If your child has speech or hearing difficulties, bring it up at routine checkups
• If your child has dental problems, make an appointment with a dentist

Diagnosis

Most clefts are found at birth when the doctor examines the baby. A cleft palate that is not visible may be found when a baby has feeding problems or a doctor feels inside the mouth.

Tests that may be done

• A physical exam of the baby's face and mouth
• An ultrasound during pregnancy can sometimes show the cleft before birth
• Hearing tests to check for related hearing issues

What to expect at your appointment

If your child is diagnosed with a cleft, you will be connected with a specialist team. This team may include a surgeon, speech therapist, dentist, and hearing specialist. They will create a plan tailored to your child's needs.

Treatment

Cleft lip and cleft palate are treated with surgery, usually in the first year of life, and with ongoing support for feeding, speech, hearing, and dental care. Treatment is planned by a specialist team.

Self-care at home

• Use special feeding bottles or nipples if your baby has trouble sucking
• Keep the surgical area clean and follow your care team's instructions after surgery
• Attend regular follow-up appointments for hearing, speech, and dental checks

Medical treatments

Surgery is the main treatment. Cleft lip repair is often done when the baby is about 3 to 6 months old. Cleft palate repair is usually done between 6 and 12 months of age. After surgery, your child may receive pain relief medicines, but you should only give the medicines your care team prescribes. Speech therapy, hearing care, and dental treatments may also be needed over time.

When is surgery considered?

Surgery is recommended as early as safely possible. Cleft lip repair is usually done in the first few months of life, and cleft palate repair before the first birthday. This timing helps with feeding, speech, and hearing development.

Living with this condition

A child with a cleft needs routine care like any child, plus extra attention to feeding, speech, hearing, and teeth. Feeding may take longer, and you may need to try different bottle types or positions. Regular checkups help catch problems early.

Lifestyle tips

• Keep a feeding diary to make sure your baby is gaining weight well
• Watch for signs of ear infections, such as pulling at the ears or fever
• Brush teeth carefully and see a dentist regularly
• Encourage your child to talk and read to them every day to help speech development

Diet and exercise

After cleft surgery, your child may need a soft diet for a while. Most children can eat and exercise normally once they have healed. Your care team will give specific advice about what to eat and how to care for the mouth after surgery.

Mental health and emotional wellbeing

Growing up with a visible difference can affect a child's confidence, especially in school or with peers. This is normal. Talking openly about feelings, involving your child in their own care, and seeking counseling when needed can all help.

Prevention

Most clefts cannot be prevented, but there are steps that may reduce the risk. Taking folic acid before pregnancy and during early pregnancy is strongly recommended. Not smoking during pregnancy and keeping diabetes well controlled can also help.

Vaccines

There are no specific vaccines to prevent cleft lip or cleft palate. It is important for pregnant women to stay up to date with routine vaccines, as some infections during pregnancy can increase the risk of birth conditions. Ask your doctor for the recommended vaccination schedule for pregnancy.

Screening programmes

A cleft can sometimes be seen on an ultrasound during pregnancy, usually at the 20-week scan. This does not mean all clefts are found before birth, and it is not a routine test for every pregnancy.

Complications

If left untreated

• Feeding difficulties that may lead to poor weight gain
• Speech problems and difficulty making certain sounds
• Repeated ear infections and possible hearing loss
• Dental problems such as missing, crooked, or extra teeth
• Social and emotional challenges related to a visible difference

Long-term outlook

With the right treatment and support, the outlook is very positive. Most children who have cleft surgery grow up to speak well, feed normally, and have healthy teeth and hearing. They can go to school, make friends, and lead full, active lives. Your cleft team is there to help every step of the way.

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