Cleft Lip And Palate

Overview

A cleft lip is a gap in the upper lip. A cleft palate is a gap in the roof of the mouth. These gaps happen before a baby is born, when the face and mouth do not join together fully. A child can have one, both, or neither. Cleft lip and palate are treatable, and care usually involves a team of health professionals.

Cleft lip and palate are among the more common birth differences. Rates vary around the world, but they affect many thousands of babies each year.

They can affect any baby. Some families have a higher chance because of family history or certain health conditions, but most cases happen without a clear cause.

Symptoms

Common symptoms

• A visible gap or split in the upper lip
• A gap in the roof of the mouth that may be seen or felt during an exam
• Milk or food coming out of the nose during feeding
• Slow feeding, poor sucking, or tiredness during feeds
• A nasal-sounding voice or speech that is hard to understand
• Frequent ear infections or hearing problems

Symptoms in children

• Trouble latching on or staying latched during feeding
• Slow weight gain or poor growth
• Speech sounds that are nasal or unclear
• Dental problems, missing teeth, or teeth in an unusual position
• Ear infections or fluid behind the eardrum
• Teasing or confidence concerns related to scars, speech, or appearance

Symptoms in older adults

• Ongoing speech differences or nasal-sounding voice
• Dental or orthodontic needs related to the cleft
• Hearing concerns from repeated ear problems in childhood
• Scar or appearance concerns
• Emotional or social effects from growing up with a cleft

Causes

Main causes

• The upper lip and roof of the mouth form early in pregnancy. A cleft happens when these parts do not join completely.
• In most cases, the exact cause is not known. It is likely a mix of genes and things that happen during pregnancy.
• Sometimes a cleft is part of a genetic syndrome or another health condition.

Risk factors

• Family history of cleft lip or palate
• Certain genetic conditions
• Smoking or drinking alcohol during pregnancy
• Poor nutrition during pregnancy
• Diabetes before pregnancy that is not well managed
• Some medicines taken during pregnancy; always ask a healthcare provider before starting or stopping any medicine

When to see a doctor

See a doctor urgently if:

• Your baby has trouble breathing, turns blue or grey, or cannot feed
• Your baby is not having wet nappies, is very sleepy, or seems dehydrated
• Your baby has a fever, especially if under 3 months old
• There is swelling, redness, pus, or a lot of pain after surgery
• Your child has sudden hearing loss, severe ear pain, or fluid draining from the ear

Book a routine appointment if:

• Your baby feeds slowly, loses weight, or milk comes out of the nose
• You have questions about surgery, feeding, speech, hearing, or dental care
• Your child's speech is hard to understand or sounds very nasal
• Your child has repeated ear infections or seems not to hear well
• You are planning a pregnancy and have a family history of cleft lip or palate

Diagnosis

A cleft lip can sometimes be seen on an ultrasound during pregnancy. A cleft palate is often found during a physical exam after birth. A healthcare provider will look inside the baby's mouth and check feeding.

Tests that may be done

• Physical exam of the lip, mouth, and palate
• Feeding observation and growth checks
• Hearing tests, often starting in infancy
• Dental and orthodontic checks as the child grows
• Speech and language assessment when the child is older
• Genetic counseling if a syndrome or family history is suspected

What to expect at your appointment

The exam is quick and not painful. Your baby may be referred to a cleft team, which can include surgeons, feeding specialists, speech therapists, dentists, hearing specialists, and nurses. Early support can help with feeding and planning care.

Treatment

Treatment is planned by a cleft team and is tailored to each child. It often includes surgery, feeding help, speech therapy, hearing care, dental care, and emotional support. The goal is to support feeding, speech, hearing, growth, and confidence.

Self-care at home

• Follow the feeding plan from your cleft team. Special bottles or feeding positions may be advised.
• Feed in a calm, upright position and burp your baby often if advised.
• Keep the mouth and any surgery area clean as instructed.
• Keep all appointments for growth, hearing, dental, speech, and surgery checks.
• Protect scars from sun as advised, especially in the first year after surgery.
• Ask for help if feeding is stressful or your baby is not gaining weight.

Medical treatments

Care may include surgery to close the lip or palate, speech therapy, hearing tests and ear care, dental and orthodontic treatment, nutrition support, and counseling. A team will decide what is needed and when. No specific medicines are recommended here; ask your healthcare provider about any treatment.

When is surgery considered?

Cleft lip repair is often done in the first year of life, commonly around 3 to 6 months. Cleft palate repair is often done around 9 to 12 months. Some children need more surgery later, such as for speech, the nose, or dental needs. The exact plan depends on the child and the cleft team.

Living with this condition

Daily life may include feeding routines, therapy appointments, hearing checks, dental visits, and school support. Many families settle into a rhythm with help from their cleft team.

Lifestyle tips

• Keep a smoke-free home to support breathing and ear health.
• Encourage good oral hygiene and regular dental visits.
• Use hearing protection around very loud sounds and treat ear problems early.
• Support your child in school and talk with teachers about speech or hearing needs.
• Build confidence by praising effort and encouraging hobbies and friendships.

Diet and exercise

Most children can eat a normal diet for their age unless their team advises otherwise. After surgery, follow the team's plan for textures and drinking. Physical activity is usually encouraged, but follow advice about protecting the surgery area for a short time.

Mental health and emotional wellbeing

Children and parents may feel worried, stressed, or self-conscious. Teasing or speech concerns can affect confidence. Talk with your team, school, or a counselor if you or your child feel overwhelmed. If you or your child feel hopeless or in crisis, contact your local emergency services or crisis support right away.

Prevention

Cleft lip and palate cannot always be prevented, and no parent should blame themselves. Good prenatal care may lower some risks. Avoid smoking and alcohol during pregnancy, eat well, manage health conditions with your provider, and review all medicines with a healthcare professional before pregnancy if possible.

Vaccines

Routine childhood vaccines are recommended for all children. No vaccine prevents cleft lip or palate.

Screening programmes

Prenatal ultrasound may show a cleft lip, but not all clefts are seen before birth. A newborn physical exam checks the mouth and palate. Hearing tests and growth checks are also important.

Complications

If left untreated

• Feeding problems that can lead to poor growth or dehydration
• Speech delay or speech that is hard to understand
• Repeated ear infections and hearing loss
• Dental problems, missing teeth, or teeth in unusual positions
• Social and emotional challenges from teasing or appearance concerns

Long-term outlook

With timely care from a cleft team, most children do well. Some may need ongoing speech, hearing, dental, or surgical care, but support is available. Many people with cleft lip and palate live full, healthy, and confident lives.

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