Pediatric Cleft Lip/Cleft Palate

Cleft lip and palate are openings or splits in the upper lip or roof of the mouth (palate). A baby 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 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 born with cleft lip or palate are at an increased risk of having babies born 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 completely
• Roof of the mouth does not close completely
• Neither the lip nor the roof of the mouth closes completely

A cleft lip and palate can be seen during the first exam by your baby’s healthcare provider.

Both cleft lip and palate can be fixed with surgery. The first surgery for cleft lip is usually done before a baby is one year old, but as early as possible. In general, a baby should be at least 10 weeks old and weigh at least 10 pounds. Typically, the first surgery for cleft palate is done before a baby is 18 months old, but again, is encouraged 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
• 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. Your 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 as well as problems with the jaw

Cleft lip and 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 trying to 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 during your pregnancy
• Don’t consume alcohol during your 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 provide the best care for your child. 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 just a cleft lip usually does not have trouble feeding. To help with feeding, try the following:

• Breastfeeding is encouraged. It will take extra time and patience. You may also pump your breast milk and feed it to your baby using special nipples and bottles
• Hold your baby in an upright position to help him or her swallow and to keep milk from going into the nose
• Try small, frequent feedings. This can help your baby get more calories and gain weight
• Many types of bottles and nipples are available for a baby with cleft palate. Talk with your child’s healthcare provider about the best type of bottle or nipple for your baby