Cleft Lip and Cleft Palate, Pediatric
Cleft Lip and Cleft Palate, Pediatric

Cleft Lip and Cleft Palate, Pediatric

A cleft lip is an opening in the upper lip. A cleft palate is an opening in the roof of the mouth (palate). Cleft lip and cleft palate (orofacial clefts) are birth defects that occur when the upper lip or the palate does not develop completely before birth. Normally, in the womb, the upper lip and the palate each develop as two halves that grow toward each other to come together (fuse) in the middle.
  • A cleft lip happens when the lip does not fuse completely. This opening may be small, or it may be so severe that it extends into the nose.
  • A cleft palate happens when the roof of the mouth does not fuse properly. The front or back part of the palate may be open at birth. In severe cases, both parts of the palate are open.
A baby can be born with either a cleft lip or a cleft palate, or with both conditions. These conditions may affect one side (unilateral) or both sides (bilateral) of a baby's face. Babies with cleft lip or cleft palate have difficulty feeding by breast or bottle because they cannot form a good seal around the nipple with their mouth. Because of this, babies may:
  • Not take in enough milk during feeding, eventually leading to malnutrition or problems with growth.
  • Spend extra effort and time during feeding, leading them to become extra tired.
  • Have milk pass into the nasal passages or inner ear, leading to ear infections.

What are the causes?

The exact cause of a cleft lip or cleft palate is unknown. Sometimes, cleft lip and cleft palate occur with other conditions or are part of a syndrome.

What increases the risk?

Your child may have a higher risk of a cleft lip or palate if he or she has:
  • A family history of the condition.
  • Certain changes in his or her genes (genetic mutations).
  • A genetic condition, such as Down syndrome.
There may also be a higher risk of these conditions if a pregnant woman:
  • Takes certain medicines during early pregnancy, including epilepsy medicines.
  • Abuses alcohol or abuses drugs.
  • Smokes.
  • Has diabetes.

What are the signs or symptoms?

An opening in the upper lip or the roof of the mouth is the main symptom of this condition. Cleft palates may not always be seen. Signs that a baby may have a cleft palate include:
  • Difficulty feeding.
  • Slow weight gain or no weight gain.
  • Frequent ear infections.
  • Hearing problems.
  • Trouble with speech development.
  • Dental problems.
  • Breathing difficulties.

How is this diagnosed?

Your child's health care provider can diagnose these conditions during a routine ultrasound during pregnancy. They may also be visible at birth or during a routine physical exam shortly after birth.

How is this treated?

Treatment for a cleft lip or cleft palate depends on your child's age and the severity of his or her condition. Surgery is the most common treatment.
  • A cleft lip is often repaired with surgery a few months after birth.
  • A cleft palate may be repaired with surgery when your baby is 9‒18 months old.
Surgery will make it easier for your child to eat and breathe. Correcting these conditions can also help prevent problems with speech, language, and hearing development. Some children may need more surgeries later in life. Your child may also need treatment for any related genetic conditions.
Your child's treatment plan may involve a team of health care providers, including specialists to help with:
  • Teeth problems or deformities (pediatric dentist or orthodontist).
  • Feeding problems and speech delays or disorders (speech therapist).
  • Hearing issues (audiologist).
  • Ear problems (otolaryngologist or ENT specialist).
  • Self-esteem issues or general mental health (psychologist).
Treatment often occurs over the course of several months or years. Depending on your child's condition, he or she may have initial treatments as a baby, then continue with treatments into adolescence.

Follow these instructions at home:

  • If you are breastfeeding your baby, talk with a lactation specialist who can help you with:
    • Proper positioning.
    • Techniques to create a good lip seal.
    • Management of milk supply.
    • Expressing milk for supplemental feedings.
  • If you are bottle-feeding, work with a feeding specialist who can help you with:
    • Identifying which type of bottle may work best for your baby.
    • Techniques to create a good lip seal and to pace feeding.
  • Work closely with your child's team of health care providers.
  • Give your child over-the-counter and prescription medicines only as told by your child's health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important. Babies with cleft lip or cleft palate must be monitored to make sure they are properly hydrated and gaining weight.

Contact a health care provider if:

  • Your child has a fever.
  • Your child is not feeding well.
  • Your child does not gain weight over several months or your child loses weight.
  • Your child does not communicate verbally by 18 months of age.
  • Your child does not have teeth by 18 months of age.
  • Your child has problems with hearing.

Get help right away if:

  • Your child is unable to feed.
  • Your child is having trouble breathing.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.