Cleft lip and palate
clefts; lip; palate; feeding; difficulty; speech; oral; facial; cleft; mouth;
Contents
Cleft lip and cleft palate may occur together or separately in a newborn child. They may be found early in a pregnancy by ultrasound examination, or at birth. A cleft lip affects a baby's and child's appearance, while a cleft palate will affect feeding and if not treated may cause speech problems.
These problems can usually be treated very successfully by surgery, which is started in the first few months of the baby's life. Several operations may be needed.
How does a cleft lip or palate happen?
- In the very early weeks of a baby's development, the two sides of the mouth are separate. At about 6 weeks after conception, the sides start to join together, beginning with the palate (the roof of the mouth), then forward to the upper lip and backwards to the soft palate.
- In about 1 baby in 800, the sides of the lip, or the lip and palate, or the palate alone, do not completely join together, leaving a gap, called a 'cleft'.
- A cleft lip can occur on one side or both sides, and can vary from a small dent in the edge of the lip to a wide gap than goes up into the opening of the nose.
- A cleft palate means that there is a hole in the roof of the mouth making a connection between the mouth and the nose (nasal cavity).
Why does a cleft lip or palate happen?
The causes of cleft lip/palate are not well understood.
- Babies are a little more likely to have a cleft if another person in the family (such as a parent or brother or sister) has a cleft, but the risk is still small (somewhere between 2 and 8%).
- There may be environmental factors, such as some drugs (including some drugs used for epilepsy), maternal alcohol use or smoking. If a mother takes extra folate before pregnancy and during the first few weeks of pregnancy she may reduce the risk of her baby developing a cleft.
- Babies who have clefts often have other birth defects, the causes of which are also not well understood.
What problems can a cleft lip or palate cause?
- Babies with a cleft palate will usually have difficulty feeding because they will not be able to form a seal around a nipple or teat which means they cannot suck strongly from the breast or a teat.
- There are many ways that these babies can be helped to feed, including the use of special teats and bottles, and sometimes a small plastic plate to cover the cleft in the mouth.
- It may be necessary to express breastmilk and give it by a bottle.
- Feeding may be slow, and sometimes the babies do not gain weight as quickly as desired.
- It is important to get specialist help if there are problems feeding a baby with a cleft palate. Referrals to the local Cleft Palate Unit will usually be made as soon as a baby is born (or earlier if the problem is detected before birth). Members of the unit will be able to help with feeding problems.
- Babies with a cleft lip but not a cleft palate will usually not have feeding problems due to the cleft lip. They can breastfeed, but the mother may need to block the cleft with her thumb or breast tissue to enable the baby to get a good seal on the breast.
- Children with cleft palates are likely to have more ear infections than other babies, and these can affect their hearing.
- Some children with a cleft palate have difficulty with speech, though this is usually improved when the cleft is closed. Some children will need ongoing speech therapy.
- Often a child's teeth will not develop normally in the area of the cleft, and the child will need orthodontic and other dental treatment.
- A cleft lip affects the appearance of a child, and even when well repaired, there will be a small scar, which can affect how the child sees himself. The scar may be able to be improved when the child is a teenager. The topic Self-esteem has ideas which may help support a child who is unhappy about his appearance.
Repairing the clefts
Surgery is done to repair the clefts. The exact timing of the surgery will depend on the specific nature of the defects that the baby has, and the health of the baby, but generally:
- A cleft lip may be operated on when the baby is 2 to 3 months old.
- The first operation on a cleft palate may be done between 9 and 18 months. The child may need several operations to fully repair a cleft palate, depending on how big the cleft is.
Caring for a baby with a cleft lip and/or palate
A family will usually be referred to an expert team very soon after the child's birth (or maybe earlier). The team will usually include a plastic surgeon, dental surgeon, ear, nose and throat surgeon, speech therapist and nutritionist.
If a baby with a cleft lip and/or palate is not feeding well, or is having ear infections, these could well be due to the birth defect. However, it is important to remember that difficulties in caring for a new baby may not all be due to a birth defect such as cleft palate. For example, many young babies cry a lot during the first few weeks of their life, and do not sleep well. The topicsCrying baby, and Sleep – birth to 3 months have some useful ideas for settling an unhappy baby.
Many parents find that after the birth of a child with a birth defect, they feel quite distressed and guilty, even when it is clear that they did not cause the problem and could not have prevented it. Caring for a baby who cannot feed well can also be quite exhausting. It is important for parents, especially mothers, to take good care of themselves, accept help when it is offered, and use the cleft lip and palate team for advice and expertise. The team can also be used as a defence against too much advice from people who do not have expert knowledge about caring for a baby with these problems. The topic Post natal depression has information which may be useful if you find you are becoming very distressed, or having trouble sleeping, relaxing or doing normal activities.
Resources
South Australia
Cleft Palate Clinic, Flinders Medical Centre
– telephone (08) 8204 4188
http://www.flinders.sa.gov.au/community/default.asp?web=community&group=dental&id=AAP_PCBz_z
Cleft Pals SA
http://www.cleft-sa.sohot.com.au/index.htm
Australia
Medicare cleft lip and cleft palate scheme
This helps families meet the treatment costs for specialised services for cleft lip and palate conditions until the child is 28 years old.
Cleft Pals - links page - for resources in Australia
http://www.cleft-sa.sohot.com.au/Links.htm
References
Medlineplus. Cleft lip and palate:
http://www.nlm.nih.gov/medlineplus/cleftlipandpalate.html
Nemours Foundation - Kidshealth.org. Cleft Lip and Palate
http://www.kidshealth.org/parent/medical/ears/cleft_lip_palate.html
March of Dimes. 'Cleft lip and cleft palate'
http://www.marchofdimes.com/pnhec/4439_1210.asp
Better Health Channel, Victoria. 'Cleft lip and cleft palate'
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.