Cleft Lip and Palate
A gap in the lip or roof of the mouth present at birth
Quick Facts
- Type: Birth difference (congenital)
- Affected area: Lip, roof of the mouth, or both
- Treatment: Surgical repair, usually in infancy
- Outlook: Generally very good with team care
Overview
Cleft lip and cleft palate are among the most common birth differences. They happen when the tissues that form the upper lip or the roof of the mouth (the palate) do not fully come together during early pregnancy, leaving a gap. A baby can be born with a cleft lip, a cleft palate, or both, and the opening can be on one or both sides.
A cleft can range from a small notch in the lip to a wide opening that extends into the nose and through the roof of the mouth. While a cleft affects feeding, speech, and the appearance of the face, modern surgical repair and team-based care lead to very good outcomes for most children, who go on to eat, speak, and develop normally.
Symptoms
A cleft lip is usually visible at birth or even on a prenatal ultrasound. A cleft palate may be less obvious, especially if the lip is not affected. Features and related effects can include:
- A split or gap in the upper lip, on one or both sides
- An opening in the roof of the mouth that may extend into the nose
- Difficulty feeding, as a baby may struggle to create suction
- Milk or formula coming back through the nose during feeding
- Frequent ear infections and possible hearing problems
- Speech difficulties and dental differences as the child grows
A cleft palate hidden under the lining of the mouth (submucous cleft) may only be noticed later because of feeding or speech issues.
Causes
In most children the exact cause is not known. Clefts are thought to result from a combination of genetic and environmental factors that affect how the face forms in the first weeks of pregnancy.
- Genetics: A family history of clefts increases the chance, and clefts can be part of certain genetic syndromes.
- Environmental factors during pregnancy: Smoking, heavy alcohol use, certain medications, and some illnesses or nutritional gaps (such as low folate) have been linked to higher risk.
Often a cleft occurs on its own in a baby with no family history and no identifiable cause.
Risk Factors
- A family history of cleft lip or palate
- Smoking, alcohol use, or certain medications during pregnancy
- Diabetes present before pregnancy
- Low intake of folic acid before and in early pregnancy
- Being part of a genetic syndrome that includes clefts
Diagnosis
Many clefts are found before or right after birth:
- Prenatal ultrasound: Can often detect a cleft lip during routine pregnancy scans, though a cleft palate alone is harder to see.
- Newborn examination: A cleft lip is visible at birth, and the doctor checks inside the mouth for a cleft palate.
- Further evaluation: Hearing tests, feeding assessments, and sometimes genetic evaluation help plan care and check for related conditions.
Treatment
Treatment is provided by a team of specialists over several years and is tailored to the child. The main treatment is surgical repair.
- Cleft lip repair: Usually done in the first several months of life to close the lip and improve appearance and function.
- Cleft palate repair: Typically performed within the first year or so to allow normal feeding, speech, and palate function.
- Feeding support: Special bottles and techniques help babies feed well before surgery.
- Ongoing care: Speech therapy, dental and orthodontic care, ear and hearing care, and sometimes additional surgeries as the child grows.
With this coordinated care, most children achieve good speech, eating, hearing, and appearance.
Prevention
- Take folic acid before and during early pregnancy as advised
- Avoid smoking and alcohol during pregnancy
- Discuss all medications with a doctor before and during pregnancy
- Manage conditions such as diabetes before becoming pregnant
- Consider genetic counseling if there is a family history of clefts
When to See a Doctor
A cleft is identified by the medical team at or before birth, and care is arranged early. Contact your child's doctor if your baby is not feeding well or is not gaining weight, if milk comes through the nose, or if you notice frequent ear infections or hearing concerns. Seek prompt care if a baby has difficulty breathing or persistent feeding trouble, so support and a care plan can be put in place quickly.
Frequently Asked Questions
Can a cleft lip and palate be repaired?
Yes. Cleft lip is usually repaired in the first few months of life and cleft palate within about the first year. With surgery and team-based care, most children go on to eat, speak, hear, and develop normally.
What causes cleft lip and palate?
In most cases it results from a mix of genetic and environmental factors affecting how the face forms in early pregnancy. Family history, smoking, alcohol, certain medications, and low folate during pregnancy can raise the risk, but often no clear cause is found.
How do babies with a cleft feed?
Babies with a cleft, especially of the palate, can have trouble making suction. Special bottles and feeding techniques usually allow them to feed well and gain weight before and after surgery, and a feeding specialist can help.
Will my child have speech or hearing problems?
Some children need speech therapy and may have more ear infections that can affect hearing, particularly with a cleft palate. With regular hearing checks, ear care, and speech support, most children develop clear speech and good hearing.
References
- Centers for Disease Control and Prevention (CDC). Facts about Cleft Lip and Cleft Palate.
- Mayo Clinic. Cleft lip and cleft palate.
- MedlinePlus, U.S. National Library of Medicine. Cleft lip and palate.
- American Cleft Palate-Craniofacial Association. Cleft Lip and Palate.