Cleft Palate And Cleft Lip

Overview

A cleft lip is a gap or split in a baby's upper lip. A cleft palate is a gap in the roof of the mouth (the palate). Both happen very early in pregnancy, in the first few weeks, when the parts of a baby's face and mouth normally join together and don't quite meet. A baby can be born with a cleft lip, a cleft palate, or both. The gap can be small or large, on one side or both sides. It is not caused by anything the parents did or didn't do.

Yes. Cleft lip and cleft palate are one of the most common differences a baby can be born with. About 1 in every 700 babies is born with a cleft lip, a cleft palate, or both. Some babies have other family members with a cleft, but most do not.

Any baby can be born with a cleft, in any family and any part of the world. It happens slightly more often in boys when it's a cleft lip, and slightly more often in girls when it's a cleft palate alone. Having a close relative with a cleft makes it a little more likely, but most babies with a cleft have no family history at all.

Symptoms

Common symptoms

• A visible split or gap in the upper lip, sometimes running up to the nose
• A gap in the roof of the mouth that may be felt with a finger or seen when the baby cries
• Milk leaking out of the baby's nose during feeds
• Difficulty latching on or sucking, so feeds take a long time
• Slow weight gain or poor feeding in the first weeks
• A nasal-sounding voice once the child starts to talk
• More frequent ear infections and glue ear (fluid behind the eardrum)
• Teeth that come through crooked, missing or in an unusual position

Symptoms in children

• Speech that sounds nasal or unclear, or sounds that are hard to make
• Speech and language delay compared with other children the same age
• Repeated ear infections or hearing problems
• Dental problems, such as crowded or missing teeth or a bite that doesn't line up
• Teasing or questions from other children about a scar or how speech sounds
• Needing extra help at school with listening or talking

Symptoms in older adults

• A scar on the lip or a changed shape of the nose from childhood surgery
• Speech that still sounds nasal, or hearing loss from repeated ear problems in childhood
• Dental or jaw problems, including a bite that doesn't fit together well
• Loud snoring or breathing pauses during sleep (sleep apnoea) in some adults
• Adults who never had repair surgery, often in places with limited access to care, may still have feeding, speech and dental difficulties

Causes

Main causes

• Cleft lip and cleft palate happen when the tissues that form the lip and the roof of the mouth don't join completely during the first 6 to 10 weeks of pregnancy
• A mix of genes and things in the environment during pregnancy is usually involved, rather than one single cause
• Some clefts are part of a wider genetic condition, which a specialist can look into
• In most cases, no clear cause is ever found, and nothing the parent did caused it

Risk factors

• Having a parent or sibling born with a cleft
• Smoking during pregnancy
• Drinking alcohol during pregnancy
• Poor nutrition in early pregnancy, including not getting enough folic acid
• Diabetes before pregnancy that is not well controlled
• Taking certain medicines in early pregnancy — always check with a doctor or pharmacist before stopping or starting any medicine
• Being very overweight before pregnancy

When to see a doctor

See a doctor urgently if:

• Your baby is not feeding well, is losing weight, or has fewer wet nappies than usual
• Your baby seems dehydrated — dry mouth, sunken eyes, very sleepy, or no tears when crying
• A fever in a baby under 3 months old, or any fever with poor feeding
• Signs of infection at a surgery site, such as redness, swelling, heat, pus or worsening pain
• Ear pain, ear discharge, or a sudden drop in hearing
• Breathing that sounds noisy or effortful, or feeds that regularly cause choking

Book a routine appointment if:

• Your baby has a cleft and you have not yet been referred to a specialist cleft team
• You are finding feeding hard and would like help with positions, bottles or teats
• You have questions about the timing of surgery or what happens next
• Your child's speech is unclear or sounds nasal
• You notice dental problems, or your child's teeth are not coming through as expected
• Your child seems to be struggling at school, socially, or with confidence
• You are expecting a baby and a cleft has been seen on a scan

Diagnosis

A cleft lip is often seen on a routine pregnancy ultrasound scan, usually in the middle months of pregnancy. A cleft palate is harder to see on a scan, so it is often found during the newborn physical check, or when a midwife or nurse notices feeding difficulties. Sometimes a parent notices milk coming out of the baby's nose. Once a cleft is found, your baby will be referred to a specialist cleft team who will check feeding, hearing, speech and general health.

Tests that may be done

• Pregnancy ultrasound scan, which may show a cleft lip and sometimes a cleft palate
• Physical examination of the baby's mouth, lip and palate after birth
• Watching a feed to see how well the baby sucks and swallows
• Hearing tests, as children with a cleft are more likely to have fluid behind the eardrum
• A check with a speech and language therapist as the child grows
• Sometimes blood tests or a genetics appointment to look for a related condition
• Sometimes a heart scan, because some children with a cleft also have a heart difference that needs checking

What to expect at your appointment

You will usually meet a whole team rather than one doctor. The team may include a surgeon, a feeding specialist, a speech and language therapist, an ear, nose and throat specialist, a dentist or orthodontist, a hearing specialist, a nurse and a psychologist. Appointments are friendly and practical — they will watch your baby feed, answer your questions and agree a plan with you. You are always part of the decisions. Write down your questions before each visit, and bring someone with you if that helps.

Treatment

Treatment for a cleft is a team effort that starts soon after birth and continues as your child grows. The main step is surgery to close the gap, but feeding support, hearing checks, speech therapy and dental care matter just as much. The aim is to help your child feed well, hear well, speak clearly and feel confident.

Self-care at home

• Feed your baby in a more upright position and take breaks to burp — this helps reduce milk leaking through the nose
• Ask your cleft team about specialised feeding bottles and teats, which make it easier for a baby with a cleft palate to feed
• Keep the lip and mouth clean with gentle wiping and normal gentle hygiene, as your team advises
• Follow the scar care plan you are given, including protecting the scar from strong sun once it has healed
• Keep up with hearing tests, dental check-ups and speech appointments, even when everything seems fine
• Clean your child's teeth gently twice a day from the moment the first tooth appears
• Look after yourself too — rest when you can, accept offers of help, and share how you are feeling with someone you trust

Medical treatments

Care usually involves a specialist cleft team working together. Feeding support is offered first, using specialist bottles and positions to help your baby get enough milk. Surgery is then planned to close the cleft lip and, later, the palate. Speech and language therapy helps with talking and listening from an early age. Ear, nose and throat specialists check hearing and treat fluid or infections, and may recommend small ear tubes for some children. Dentists and orthodontists look after teeth and jaw alignment, sometimes with braces or other appliances. Hearing aids may be suggested if hearing is affected. Psychological support is available for children and families if worries about appearance, speech or confidence come up. Any medicines that are needed are always prescribed and explained by your own clinical team.

When is surgery considered?

Surgery is usually recommended in the first year of life. Many teams close a cleft lip at around 3 to 6 months of age, and a cleft palate at around 6 to 12 months, so that speech can develop well. Some children need further surgery later — for example to help with speech, to close a small hole left in the palate, to improve the shape of the nose, or to help the jaw line up. Your surgeon will explain the timing and reasons for each operation, the risks, and what recovery involves. Surgery is not usually done before other health checks are complete.

Living with this condition

Day to day life with a child who has a cleft is mostly ordinary family life, with a few extra appointments along the way. Feeds may take longer at first, and you may find your own routine with positioning and specialist bottles. As your child grows, keep speech practice relaxed and playful, and let them ask questions about their scar when they are ready. Many families find that talking openly and simply about the cleft — using the words their cleft team uses — helps children feel comfortable and confident.

Lifestyle tips

• Keep a simple folder or phone note of appointments, questions and answers so nothing gets lost
• Tell nursery, childminders and school about the cleft and any hearing or speech needs, so they can support your child well
• Encourage normal play, sport and swimming — a healed scar does not need to limit activity
• Protect the scar from strong sun with hats, shade and sun cream once healed, as scars can darken
• Build a small support network of other families — talking to someone who has been through it helps a lot
• Give siblings simple explanations too, so they feel included and understand what is happening

Diet and exercise

Breast milk or formula is the only food a baby needs in the first months — your team will help you find the feeding method that works for your baby. When it is time to start solid foods, go at your child's pace with soft, smooth textures and let them get used to new spoons and tastes. As children grow, offer a balanced everyday diet with plenty of fruit, vegetables and calcium for growing teeth and bones. There are no special exercise limits: running, climbing, swimming and team sports are all good for children with a cleft and help build confidence.

Mental health and emotional wellbeing

It is very common for parents to feel shock, guilt, worry or grief when a cleft is found, and for children to feel self-conscious about a scar or their voice as they get older. These feelings are understandable and they do ease, especially with good support. Talk to your cleft team or family doctor if low mood, worry or sleep problems are lasting more than a couple of weeks, or if your child seems withdrawn, anxious or is being teased. If you or your child ever feels hopeless or unsafe, contact your local crisis support service or your local emergency number straight away — you deserve help right away, and help is available.

Prevention

A cleft cannot be completely prevented, and it is not your fault if your baby has one. Some steps are linked with a lower chance of birth differences in general: avoiding smoking and alcohol during pregnancy, eating a healthy diet, and getting health conditions such as diabetes well controlled before pregnancy. If you are planning a pregnancy and have a family history of cleft, or you take regular medicines, talk to your doctor before you conceive so your care can be planned safely.

Vaccines

There is no vaccine that prevents a cleft. Routine childhood vaccinations are still important for all children, including children with a cleft, and are usually given as normal. If your child is due surgery, your team will tell you if any vaccination timing needs adjusting.

Screening programmes

A cleft lip can often be seen on the routine pregnancy ultrasound scan offered in the middle months of pregnancy. A cleft palate is harder to see before birth, so all newborn babies have a physical check that includes looking inside the mouth. If a cleft is found, extra checks on hearing, feeding and sometimes the heart are arranged. Ask your midwife or doctor about what scans and newborn checks are offered where you live.

Complications

If left untreated

• Feeding difficulties that can lead to poor weight gain and, in severe cases, dehydration
• Speech that is hard to understand, which can affect learning and confidence
• Repeated ear infections and hearing loss, which can slow speech and language development
• Dental problems, including missing, crowded or crooked teeth and bite problems
• Jaw growth differences that may need orthodontic or surgical treatment later
• Teasing, low confidence or anxiety about appearance and voice
• Without surgery, a cleft palate can also make breathing and swallowing harder, especially during feeds

Long-term outlook

The outlook for children born with a cleft is generally very good. Modern cleft care — surgery, feeding help, hearing checks, speech therapy and dental care — means most children grow up eating normally, speaking clearly and taking part in everything their friends do. Some children need extra appointments or more than one operation along the way, and that is a normal part of the journey rather than a sign something has gone wrong. Your cleft team will walk with your family step by step, and there is a lot of support available.

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