Cleft Palate
An opening in the roof of the mouth present at birth
Quick Facts
- Type: Congenital (present at birth) difference
- What it is: Incomplete closure of the roof of the mouth
- Main treatment: Surgical repair
- Care team: Specialized cleft and craniofacial team
Overview
A cleft palate is a birth difference in which the roof of the mouth (the palate) does not close completely during early development in the womb. This leaves an opening between the mouth and the nasal cavity. The palate has a hard, bony front part and a soft back part, and a cleft can affect one or both.
Cleft palate may occur on its own or together with a cleft lip, which affects the upper lip. It is one of the most common birth differences. While it can affect feeding, speech, hearing, and dental development, treatment, especially surgical repair and coordinated care from a specialized team, allows most children to thrive and develop typical speech and appearance.
Symptoms
A cleft palate is usually identified at or shortly after birth, although a small cleft of the soft palate can be harder to spot. Effects can include:
- An opening in the roof of the mouth, sometimes extending into the nose
- Difficulty feeding, with milk or formula coming out through the nose
- Problems gaining weight if feeding is difficult
- Frequent ear infections and possible hearing problems
- Changes in speech, such as a nasal-sounding voice, as the child grows
- Dental problems, including missing or misaligned teeth
Causes
A cleft palate happens when the tissues that form the roof of the mouth do not fully join during early pregnancy. The exact cause is often unknown and usually involves a mix of factors:
- Genetics: Inherited genes can raise the risk, and clefts sometimes run in families or occur as part of a genetic syndrome.
- Environmental factors during pregnancy: Such as smoking, certain medications, alcohol use, or poorly controlled diabetes.
- Combination of factors: Most often a mix of genetic and environmental influences.
Importantly, in most cases nothing the parents did caused the cleft.
Risk Factors
- A family history of cleft lip or palate
- Smoking, alcohol use, or certain medications during pregnancy
- Poorly controlled diabetes during pregnancy
- Low intake of certain nutrients, such as folic acid, before and during pregnancy
- Being part of a genetic syndrome that includes clefting
Diagnosis
A cleft palate is often diagnosed during a physical examination of the newborn. Some clefts of the lip and palate can be seen before birth on a routine prenatal ultrasound, allowing families to plan care in advance.
After diagnosis, the child is usually referred to a cleft and craniofacial team. The team may evaluate feeding, hearing, and overall development, and check for any associated conditions, since a cleft is sometimes part of a broader genetic syndrome.
Treatment
Treatment is provided by a coordinated team and spans childhood:
- Feeding support: Special bottles and techniques help infants feed well before surgery.
- Surgical repair: The palate is repaired with surgery, typically within the first year or so of life, to support feeding and speech development. Timing depends on the child.
- Speech therapy: Helps with speech development as the child grows.
- Ear and hearing care: Monitoring and treatment, sometimes including ear tubes, because ear infections are common.
- Dental and orthodontic care: For teeth and jaw alignment over time.
- Additional surgeries: Some children need further procedures as they grow.
Prevention
Cleft palate cannot always be prevented, but some steps during pregnancy may lower the risk:
- Avoid smoking, alcohol, and recreational drugs during pregnancy
- Take prenatal vitamins with folic acid as advised before and during pregnancy
- Manage diabetes and other health conditions well
- Discuss any medications with a doctor before and during pregnancy
- Seek genetic counseling if there is a family history of clefting
When to See a Doctor
If a cleft palate is identified, work with a specialized cleft and craniofacial team, which guides care from infancy through childhood. Contact your child's care team about feeding difficulties, poor weight gain, frequent ear infections, or speech concerns.
Seek urgent care if a baby is choking, turning blue, or having trouble breathing during feeds, or shows signs of dehydration such as very few wet diapers, no tears, or unusual sleepiness. These need prompt medical attention.
Frequently Asked Questions
What is the difference between cleft lip and cleft palate?
A cleft lip is an opening in the upper lip, while a cleft palate is an opening in the roof of the mouth. They can occur separately or together. A cleft palate particularly affects feeding, speech, and hearing.
Can a cleft palate be repaired?
Yes. Surgery repairs the palate, usually within roughly the first year of life, and is highly successful. With repair plus feeding support, speech therapy, ear care, and dental care from a specialized team, most children develop typical speech and appearance.
What causes a cleft palate?
It results from the tissues forming the roof of the mouth not fully joining during early pregnancy. The cause is usually a mix of genetic and environmental factors, and in most cases nothing the parents did caused it.
How does a cleft palate affect feeding?
The opening between the mouth and nose can make it hard for a baby to create suction, so milk may come out through the nose and feeding can be slow. Special bottles and techniques help babies feed well until surgical repair.
Can a cleft palate be detected before birth?
Some clefts, especially those involving the lip, can be seen on a routine prenatal ultrasound, which helps families prepare. A cleft of the palate alone can be harder to detect before birth and may be found at the newborn exam.
References
- Centers for Disease Control and Prevention (CDC). Facts about Cleft Lip and Cleft Palate.
- Mayo Clinic. Cleft lip and cleft palate — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Cleft lip and palate.
- American Cleft Palate-Craniofacial Association.