A cleft lip and/or palate is a congenital deformity that affects approximately one in 800 live births, resulting in deformities that range in severity from a barely noticeable notch on the lip to a complete bilateral cleft lip and palate.

 

What causes a cleft lip or palate?

In roughly one-third of cleft cases, one of the baby’s relatives has had the condition, while two-thirds have no family history of cleft lips or palates. There is no single factor during a woman’s pregnancy that causes her child to have a cleft deformity, although several different drugs (alcohol, cigarettes, some seizure medications and vitamin A derivatives) have been shown to increase the likelihood, as well as a number of genes that are associated with cleft deformities. It is most likely, however, that a combination of these factors must be present for a cleft to occur. Children born with a cleft lip or palate must be evaluated by experienced physicians in order to make sure the child isn’t suffering from any related problems.

 

Pre-surgery care:

Corrective surgery for cleft palates is typically conducted at between nine months and one year of age. In the meantime, children born with a cleft palate (with or without a cleft lip) cannot create suction and will have great difficulty getting enough breast milk or formula which, if not properly handled, could affect the child’s growth. The problem arises from the cleft in the palate, which allows air to come through the nose when the baby tries to suck, resulting in excess air in the mouth instead of milk, which leaves the child fatigued and hungry when parents attempt to breastfeed or use a standard bottle.

To resolve this issue, parents may either enlarge the hole in the nipple of the bottle (allowing the baby to use his/her tongue to control the amount of milk) or they may opt to use a squeeze bottle. Often, a combination of these two techniques is used.

 

Treatment timeline and considerations:

Before a child is treated for a cleft lip or palate, it is crucial to complete a full physical exam and careful medical history exam, in order to determine if the child has any other health issues. Cleft lip surgery is usually performed when the child is between three and five months of age, while cleft palate operations are performed when he/she is between nine months and one year of age. The treatment for your child will depend on whether he/she has a cleft lip, palate or both, and the severity of the cleft.

Following the original corrective surgery, the child is followed annually at a cleft lip and palate clinic. Speech therapy services and careful audiology (hearing) monitoring are also crucial. Often, babies with cleft deformities will need tubes in their ears to improve hearing and avoid developing speech delays.

Many patients will also require reconstructive surgery at various stages throughout childhood and their teenage years, depending on the individual circumstances. Most children with a cleft lip will require one or more additional operation to normalize the appearance of the nose; the first of these can be performed at the time of the original cleft corrective procedure, while subsequent operations are generally scheduled before the child enters school and during his/her teenage years.

 

Post-operative instructions:

Cleft lip

  • Following surgery, the nipple of your child’s bottle should be enlarged (you can use scissors to cut the tip to make the hole bigger to avoid excessive sucking).
  • Five days post-surgery your child will return to the hospital for suture removal.
  • Painkillers may be administered to your child along with antibiotics.
  • You may shower your child the next morning.
  • All incisions must stay dry and clean.
  • Apply baneocin twice daily to the incisions.

 

Cleft palate

  • Following the surgery, your child will be monitored for one night in the hospital.
  • For the first three weeks after the surgery, only liquids may be administered.
  • Three weeks after the surgery you may administer pureed foods, while solid foods are absolutely forbidden.
  • Do not be concerned if your child snores one week after the surgery.