Cleft Lip & Cleft Palate

Early in our development in the uterus, every single one of us has a cleft lip and a cleft palate, but as normal development continues during the first trimester, the tissues that form the palate and the upper lip come together, or fuse. If that fusion doesn't happen, children are born with a cleft lip and/or a cleft palate.

How common?

The American Society of Plastic Surgeons (ASPS) considers this birth defect (Read about "Birth Defects") a common one. ASPS says it affects one in every 700 to 1000 births in the United States. The March of Dimes (MOD) calls this birth defect an oral-facial cleft. An oral-facial cleft, according to MOD, is an opening in a structure around the mouth and face. Clefts, according to MOD can occur on:

• the lip
• roof of the mouth (hard palate)
• back of the mouth (soft palate)

There are two major types of oral-facial clefts according to MOD:

• Cleft Lip/Palate - in this case the baby has a cleft lip, usually accompanied by a cleft palate
• Isolated Cleft Palate - the cleft palate occurs by itself. This is less common than the cleft lip/palate, according to MOD, occurring in about 1 of 2,000 babies.

In normal development, MOD says that the lip usually closes by 5 to 6 weeks after conception and the palate by 10 weeks. When fusion goes as planned, you can see where it occurred in the indentation on your upper lip and under your nose, and in the ridge and pale line in the middle of your palate, according to the American Academy of Family Physicians (AAFP).

Risk factors

Unfortunately, it is not yet clear what causes cleft lip/palate. According to AAFP, race and gender may play a small role. Clefts, says AAFP, are most common in Asians, less common in whites, and African Americans are least affected. (Read about "Minority Health") Girls also seem more affected than boys. Clefts can run in families, which indicates heredity could play a role. According to MOD, studies show the following factors may also contribute to clefts:

• sickness during pregnancy (Read about "Healthy Pregnancy")
• alcohol consumption (Read about "Alcoholism")
• drugs (Read about "Medicine Safety")
• infections
• lack of B vitamin known as folic acid. (Read about "Vitamins & Minerals")

While there isn't much known about how to prevent cleft lip/palate, MOD says some studies referred to prenatal vitamins as a possibility. The studies claimed that taking multivitamins containing folic acid before conception and during the first two month of pregnancy helped lower the risk of having a baby born with cleft lip/palate, and isolated cleft palate. (Read about "Prenatal Care" "Stages of Pregnancy" "Pregnancy and Nutrition")

Complications

There are a number of complications of clefts. They include:

• breastfeeding
• speech
• ear infections

There are however ways to solve the problems and deal with the issues effectively.

Breastfeeding

Breastfeeding (Read about "Breastfeeding") for a child with only a cleft lip is usually possible, according to AAFP. The same is the case for babies with a small cleft palate. There are artificial palates that can be placed in the child's mouth to help fill the gap and make nursing possible. A child with both a cleft lip and a cleft palate probably cannot nurse, but there are special baby bottle nipples designed to help the child get nourishment by bottle-feeding.

Speech

While children with cleft lip may have normal speech patterns, MOD says that children with cleft palate, whether isolated or combined with cleft lip, may not develop their speech patterns as quickly as other children. They may sound nasal, and have a hard time making consonant sounds. AAFP suggests that an artificial palate can be used in cases of a cleft palate to help a child make the beginning sounds of speech.

Ear infections

Children with clefts are more likely to have ear infections than other children, according to AAFP. That's because fluid and germs can enter into the ear more easily. (Read about "Microorganisms") AAFP says that surgically putting tubes into the eardrum to drain fluid can stop some infections. AAFP recommends children with clefts have their ears checked regularly by a doctor. (Read about "Otitis Media")

Treatments

According to AAFP, cleft lip and cleft palate are not dangerous for your child. There are treatment options for clefts. They include:

• surgery
• orthodontics

Surgery

Surgery is always an option when the child is at the right age, and is in good health. (Read about "Plastic Surgery") ASPS recommends you find a qualified plastic surgeon that has experience repairing this particular birth defect. ASPS says medical teams have formed all over the county to help parents plan for their child's care from birth. Most teams consist of more than the plastic surgeon. Dental, speech, hearing and ear, nose and throat specialists may also be involved, as well as a geneticist (Read about "Genetics"), psychologist and social worker. MOD says that cleft lip can, in most cases, be repaired by about three months of age. Cleft palate repair often takes place between 9 and 18 months of age, according to MOD. Additional surgical procedures may take place as the child grows. As with any surgery, ASPS warns there are risks, so talk with your physician before making any decisions.

Orthodontics

Children whose cleft lip/palate extends into the upper gums may have special dental problems. According to MOD, some baby and permanent teeth may be unusually shaped, out of position, or missing. An orthodontist can reposition teeth using braces while an oral surgeon can reposition segments of the jaw. A speech therapist may be called in to help, and according to MOD, most children will eventually catch up and develop normal speech.

Related Information:

    Baby and Young Child Care

    Child Development