Cleft Lip and Cleft Palate, Pediatric

A baby with a cleft lip with two insets showing a unilateral and a bilateral cleft lip.

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 are birth defects that occur when the upper lip or the palate does not develop completely before birth.

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) of a baby's face or both sides (bilateral). Babies with cleft lip or cleft palate often have difficulty feeding.

What are the causes?

The exact cause of a cleft lip or cleft palate is not known. 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.

Sometimes, cleft lip and cleft palate occur with other conditions and may be a part of a syndrome.

What increases the risk?

Your child may have a higher risk of a cleft lip or cleft palate if your child has:

A family history of the condition.
Certain changes in your child's 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?

The main symptom of this condition is an opening in the upper lip or the roof of the mouth. Cleft palates may not always be seen. Signs that a baby may have a cleft palate include:

Difficulty feeding. This is the most common problem. A baby may spend extra effort and time during feeding, leading him or her to become extra tired.
Slow weight gain or no weight gain. Babies with this condition may not take in enough milk during feeding, eventually leading to malnutrition or problems with growth.
Frequent ear infections, due to having milk pass into the nasal passages or inner ear.
Hearing problems.
Trouble with speech development.
Dental problems.
Breathing difficulties.

How is this diagnosed?

These conditions can be diagnosed during a routine ultrasound during pregnancy. They may also be diagnosed 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 ear, nose, and throat 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, your child may have initial treatments as a baby, then continue with treatments as a young child, and into adolescence.

Follow these instructions at home:

Feeding

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.

General instructions

Give your child over-the-counter and prescription medicines only as told by your child's health care provider.
Work closely with your child's team of health care providers.
Keep all follow-up visits. This is important. Babies with cleft lip or cleft palate must be monitored to make sure they are drinking enough fluid and gaining weight.

Contact a health care provider if:

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 who is younger than 3 months has a temperature of 100.4°F (38°C) or higher.
Your child who is 3 months to 3 years old has a temperature of 102.2°F (39°C) or higher.
Your child is having trouble breathing.

These symptoms may be an emergency. Do not wait to see if the symptoms will go away. Get help right away. Call 911.

Summary

A cleft lip and cleft palate are birth defects that occur when the upper lip or the palate do not develop completely before birth.
A baby can be born with either a cleft lip or a cleft palate, or with both conditions.
These conditions can be diagnosed with ultrasound before birth or with a physical exam at birth or soon after birth.
The most common problem that children with this condition experience is difficulty feeding.
Cleft lip and cleft palate are typically repaired with surgery within the first few years of life.