A cleft is when the tissues that make up the sided of the mouth do not come together all the way. There are different kinds of clefts:
- A soft palate cleft affects the soft tissue at the back of the mouth.
- A hard palate cleft affects the hard palate, toward the front of the mouth.
- A cleft can be on one side of the mouth. This is called a unilateral (yoo-nuh-LAH-er-uhl) cleft.
- A cleft can be on both sides of the mouth. This is called a (bilateral [BUY-LAT-er-uhl) cleft.
- A cleft that extends up to the nostril is called a complete cleft.
- A cleft that stops at the lip is called an incomplete cleft.
Your child may have a cleft in any combination of the lip, hard palate, or the soft palate.
Cleft lip and palate are usually diagnosed by the doctor or other healthcare provider attending the birth. This healthcare provider or your baby’s pediatrician can refer you to specialists who can discuss treatments for your baby. It’s important to get treatment early.
One out of every 700 babies born in the United States will have a cleft. More boys than girls are born with both a cleft lip and palate, but more girls than boys are born with just a cleft palate.
Doctors are not sure what causes clefts, but they probably are due to both genetic and environmental factors.
Things that may increase the chances of having a baby with a cleft lip or cleft palate include:
- Family history of cleft lip or cleft palate. Clefts are more common in some families.
- Smoking or drinking alcohol during pregnancy. Women who binge drink early in pregnancy are more likely to have a baby with a cleft.
- Not getting enough nutrients like folic acid. Taking folic acid supplements before and during pregnancy can prevent a number of birth defects, including clefts.
- Having diabetes before pregnancy.
- Having certain infections during pregnancy, such as rubella.
Cleft lip and palate are usually diagnosed when the doctor attending your birth does a physical exam of your baby. If your doctor thinks your child might have a cleft lip, they could need further tests, like x-rays, for the doctor to see bone structures in the skull.
Sometimes cleft lip or palate can also be seen in an ultrasound of an unborn baby. If you are pregnant and your unborn baby is diagnosed with cleft lip or palate, your doctor may want to get a sample of your amniotic fluid (the liquid surrounding your baby in your uterus) to test for other genetic problems.
Surgery can repair a cleft. The American Cleft Palate-Craniofacial Association (ACPA) recommends a team approach to treat children with clefts. Usually, a team is made up of the following people:
- A specialist in facial repair (a craniofacial plastic surgeon)
- An ear, nose and throat specialist (an otolaryngologist)
- A specialist in hearing (an audiologist)
- A pediatric orthodontist [or-thoh-DON-tist]
- A pediatric dentist
- A speech therapist
- A social worker
- A registered nurse
- You–the most important member of the team
The team will work together to plan therapies and surgeries that will promote a happy, healthy life for your baby.
Cleft lip and palate cannot always be prevented, but there are things you can do to make them less likely. These include:
- Take prenatal vitamins every day, both before and during pregnancy. These include folic acid, which can help prevent a number of birth defects.
- Don't smoke or drink alcohol.
- Get a health checkup before you get pregnant. Make sure any medicine you're taking is safe during pregnancy.
- Get regular prenatal care as soon as you find out you're pregnant.
- Protect yourself from infections. Make sure your immunizations are up to date, especially for rubella.
When a baby is growing in the mother’s uterus before birth, the left and right sides of the child’s face start out as separate, but they usually fuse together. This happens early in the pregnancy, in the first 4–12 weeks.
During this time, the nose, lips, and mouth form. Sometimes, the lip or the palate (upper part of the mouth) do not fuse together completely. When this happens, the baby will have a cleft lip, cleft palate, or both. Cleft lip and cleft palate are congenital [KAHN-jen-ih-TUHL] defects, which means a child is born with them.
How Does Having a Cleft Affect My Baby?
Babies born with a cleft are usually very healthy, but the cleft can cause some challenges. Every child is different. Your child may have problems with eating, drinking, hearing, and speech. The cleft may interfere with jaw growth and development or cause dental problems.
Your baby may have trouble feeding. Babies born with a cleft lip can usually nurse like other babies. Your doctor should talk to you about the possibility of breastfeeding your newborn with cleft lip. Besides its many other benefits, breastfeeding helps to strengthen the mouth and facial muscles. This is particularly helpful for a baby born with cleft lip or palate.
Babies born with a cleft palate will have a hard time making a seal around the nipple to create suction. If your baby is unable to breastfeed, you can use a breast pump and a special bottle designed to make feeding easier. Doctors who specialize in cleft palate can show you the choices available. You may have to try different products to find the one that works best for you and your child.
If your baby has cleft palate, milk may run out of their nose when feeding. This is not a health risk. Have a soft cloth on hand to wipe the milk away. Feed your baby in an upright position to help milk flow down their throat. This will decrease the amount of milk in their nose.
Babies with clefts also tend to swallow more air and need to be burped more often than other children. With time and patience, you can become an expert at feeding your baby.
- Your baby may have ear problems. There is a small tube in the ear called a eustachian [you-STAY-shun] tube. This connects the middle ear (inside the ear) to inside the nose and throat. Normally, it drains fluid from the ear. Often, the eustachian tubes in babies with cleft lips do not drain properly.
- Your baby may speech problems. If a cleft lip is not repaired, your child may have trouble making some sounds that use the lips. If your baby also has cleft palate, your baby will have trouble speaking. When a person speaks, the roof of the mouth directs sound from the vocal cords out through the mouth. With a cleft palate, sound can be directed into the nose. This means that a child with a cleft can have a nasal-sounding voice and be hard to understand. Speech therapy can help your child form sounds that can be understood by others.
- Your baby may have dental problems. Some children may need a bone graft if a part of the bone in the upper jaw is missing. X-rays will help the doctor see if your child’s teeth are affected. Sometimes teeth may be in the wrong place. Like many children, your child may need orthodontics [orth-o-DON-ticks], or braces.