Cleft lip and cleft palate

What is a cleft lip and cleft palate?

Cleft lip and cleft palate describe an abnormal cleft or gap in the upper lip or palate (roof of the mouth). About 1 out of 700 babies are born with a cleft lip or palate.

While this can cause problems with feeding, hearing and speech, all of these problems are treatable with the right support.

What causes cleft lip and cleft palate?

In normal development, the sides of the lip and palate develop separately and then fuse (join) together. This process usually happens during the early weeks of pregnancy. A cleft lip or cleft palate happen when the sides of the upper lip or palate do not fuse properly and it leaves a gap.

Most of the time, we don’t know why a particular baby is born with a cleft lip or palate. In some cases, there may be a family history of cleft lip or palate. In other cases, a baby with a cleft lip or palate may have other congenital problems.

Whatever the cause, it’s unlikely that anything you did or didn’t do during your pregnancy led to your baby having a cleft lip or palate

Can my baby have both a cleft lip and cleft palate?

Since the upper lip and palate develop separately, a baby can be born with a cleft lip or palate only, or a combination of both.

There are a few different types of cleft lip and palate. A cleft lip may develop on both sides (bilaterally) and may be small or large. The gap in a cleft palate may be large, extending from the back of the palate all the way to the gumline, or much smaller. Each situation is different and may need a different combination of treatments.

How is it treated?

Surgery is usually needed to repair a cleft lip or palate. Since cleft lip and palate are not dangerous to you child, your surgeon will probably recommend waiting to operate until your baby is the right size and weight, and in good general health.

Cleft lip surgery is usually done when your baby is at least 12 weeks old. Cleft palate surgery is usually done later when your baby is at least 9 months old.

Babies born with a large cleft (gap) or a combination cleft lip and palate may need more than one operation. Every case is different, so ask your medical team if you aren’t sure what will be needed.

Many children affected by cleft lip and/or palate are treated by a cleft team throughout their childhood. This medical team includes different types of health professionals who look after for different aspects of your child’s care. A cleft team may include a:

• surgeon
• paediatrician
• audiologist
• nurse consultant
• speech pathologist

How do I care for my baby before surgery?

Babies born with a cleft lip/or palate may have trouble feeding well. To breast or bottle-feed effectively, a baby needs to position their lips and tongue correctly around the nipple or bottle teat, and create suction and compression during sucking. Gaps in the upper lip and/or palate can make these steps more difficult.

Most babies with only a cleft lip manage to feed well. They may breastfeed better with the cleft facing upwards, so your breast can fill the gap. Bottle-fed babies may benefit from a wider-based teat.

Babies with a cleft palate will have trouble generating enough suction to feed effectively, even if it looks like they are sucking well. There are a number of special bottles and teats available that can help your baby feed more effectively.

Ask your doctor, cleft team or child health nurse who can help guide you with regard to your baby’s feeding.

How will it affect my baby's growth and development?

Hearing

Babies and children affected by cleft lip and/or palate are more likely to have ear problems, including frequent ear infections and hearing problems.

Babies with cleft lip or/palate are recommended to have hearing tests at 4 weeks old and 12 weeks old, followed by annual hearing tests during early childhood.

Speech

Children with a cleft lip do not usually have problems learning to speak.

Children affected by a cleft palate may have some trouble learning to speak, even after their cleft palate is repaired. Children with a history of cleft palate may have difficulty pronouncing consonants and may have a nasal-sounding voice.

A speech pathologist can give you information and advice about your child’s speech and language development, and can provide therapy to address specific issues.

Teeth

Many children with a cleft lip or palate will also have missing, extra or misshapen teeth. It’s important for your child to see a dentist regularly to make sure any issues are addressed early.

Medicare’s Cleft Lip and Cleft Palate Scheme covers the cost of many dental treatments your child may need throughout their life. Ask your dentist for more information.