Kids Health Info

Cleft Lip and Palate - an overview

  • Cleft lip and cleft palate describe an abnormal gap in either the upper lip or the roof of the mouth. It occurs when some parts of the mouth fail to join together during early pregnancy. The lip and palate develop separately, which means it is possible for a baby to be born with only a cleft lip, only a cleft palate, or a combination of both.

    Clefts that occur only on one side are called unilateral clefts. When the cleft affects both sides, it is called a bilateral cleft. 


    Cleft lipCleft-lip-and-palate-1.jpg


    Cleft lip and palate
    Cleft-lip-and-palate-2.jpg

     

    What causes clefts of either the lip or the palate?

    We do not know what causes a cleft lip and palate. Sometimes it can happen because there is a family history of the condition. Perhaps someone else in the family was born with a cleft lip or cleft palate. This is called 'familial'. However, sometimes a child is born with the condition when there is no family history and no known cause of the condition. This is called 'sporadic'.

    Cleft lip and cleft palate can occur by themselves or in some cases with other problems.

    Treatment

    The amount of treatment required for a child with a cleft lip or cleft palate depends on how severe the condition is at birth.

    A small cleft lip may need only one operation in the first months of life. A child with a large cleft involving the lip and palate will need several operations and ongoing care from the 'cleft team'. The cleft team at the RCH has a clinical nurse specialist who coordinates care from birth through to adulthood. Our RCH team includes:

    • audiologists
    • dental specialists
    • ear, nose and throat surgeons
    • oral and maxillofacial surgeons
    • paediatricians
    • plastic surgeons
    • speech pathologists

    Children with clefts see the cleft team from birth until their face has finished growing (usually in their late teens). There have been many improvements in surgery for children with cleft conditions over the past 10-20 years. Today, children usually only need to stay in hospital for one to three days for surgical procedures.

    How a cleft lip and palate affects children

    Your child may be affected in a number of ways by a cleft lip and palate and there are a number of important areas to consider in their care, including feeding, hearing, speech and teeth.

    Hearing

    • Children affected by cleft palate are more likely to have hearing problems and fluid in the middle ear.
    • Every baby with a cleft palate needs to have their hearing monitored closely by a hearing specialist (audiologist).  A hearing assessment should  be arranged for when the baby is around four weeks old, and repeated again at around 12 weeks of age.
    • Annual hearing tests are recommended during early childhood for children with a history of cleft palate.

    Speech

    The palate is very important in speech.

    • Children with a cleft palate may have trouble pronouncing consonants (p, b, t, d, k, g, f, v, s, z, sh, ch), and may have a very nasally sounding voice.
    • They may make unfamiliar sounds which make it difficult to understand what the child is saying. This is very frustrating to the child.
    • Speech therapy is usually helpful in eliminating these sounds and developing the sounds found in the child's native language.

    Feeding

    Please see our fact sheet on cleft lip and cleft palate feeding.

    Teeth

    • Many children born with a cleft of the lip and palate will have missing teeth, particularly in the line of the cleft.
    • They may also have extra teeth, misshapen or malformed teeth. Because of this, their teeth can be crowded, tilted or rotated.
    • It is important that your child's teeth are looked after carefully. Your child may want to have braces or other dental treatment in the future to improve their appearance, and healthy teeth are essential for this.
    • Children with a cleft should be seen by a dentist shortly after their first teeth come through.
    • At The Royal Children's Hospital this is generally scheduled for around 18-24 months of age. It is important to see a dentist experienced in the care of people with clefts.

    Key points to remember

    • Cleft lip and cleft palate affect infant feeding, hearing, speech and teeth.
    • A child born with cleft lip and cleft palate will require several operations to repair the cleft.
    • More operations may be needed during childhood, adolescence and early adulthood.
    • A hearing test should be done at around four weeks of age and again at 12 weeks of age. Hearing should be monitored closely during early childhood.
    • Your child should be monitored regularly by a dentist experienced in the care of clefts.
    • Your child's speech sounds and language development (words and sentences) should be monitored by a speech pathologist experienced in cleft care.
    • There have been excellent improvements in the treatment of cleft lip and cleft palate in the past 10-20 years.
    • Many children now achieve excellent results with their appearance, speech and teeth.
    • The Royal Children's Hospital has a large and experienced cleft team with expertise in all areas of treatment. We work together with parents to provide the most up-to-date management from birth through to adulthood.

    For more information

    • Read The Royal Children's Hospital's cleft lip and palate booklet Cleft lip and palate booklet (PDF 225 KB).
    • Your cleft coordinator can provide ongoing advice and support.
    • RCH Department of Plastic & Maxillofacial Surgery
    • Series of Kids Health Info factsheets on 'Feeding your child with a cleft palate' (under 'c').
    • CleftPaLS (the Cleft Palate and Lip Society) - www.cleftpalsvic.com:  CleftPaLS is a parent group that offers support and information to families. Members of this group are happy to visit new parents in hospital.  They provide telephone contact,and are available at any time. There is a branch of CleftPaLS in each state.  The Victorian contact telephone number can be found in the White Pages under CleftPaLS. CleftPaLS provide information packs for expecting and new parents and also supply a range of bottles and teats for babies who are unable to breastfeed or bottle feed using conventional teats and bottles. (Refer to our feeding information for advice regarding feeding your child with a cleft palate).
    • Email The Royal Children's Hospital Cleft Cranio-facial Service: cleftcraniofacial.service@rch.org.au

     

    Developed by the Department of Plastic and Maxillofacial Surgery and Speech Therapy at the RCH.  First uploaded Jan 2005. Updated October 2010

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.