What Is a Cleft?
A cleft is when a baby is born with an opening in the lip and/or roof of the mouth (palate). A baby with a cleft might have:
- only a cleft lip
- both a cleft lip and a cleft palate
- only a cleft palate
Cleft lip alone and cleft lip with a cleft palate happen more often in boys. A cleft palate without a cleft lip is more common in girls.
These birth defects — together, they're called orofacial clefts — are treatable. Most kids can have surgery to repair them within the first year or two of life.
What Are the Types of Clefts?
A cleft lip may just look like a small opening on the edge of the lip, or it could extend into the nose. It may also extend into the gums.
A cleft lip can be a:
- unilateral cleft lip: a split on one side of the lip
- bilateral cleft lip: splits on both sides of the lip
Clefts can range in size:
- Some are just a small notch in the lip (an incomplete cleft lip).
- Others extend from the lip through the upper gum and into the nostril (a complete cleft lip). This can make the baby's nose look wider and shorter than normal, especially when there are clefts on both sides of the lip.
Usually, cleft lip is found when a baby is born, although some are seen on a prenatal ultrasound.
Read more about cleft lip.
A cleft palate is when a baby is born with a cleft in the roof of the mouth. This leaves a hole between the nose and the mouth. It can be:
- a complete cleft palate: going from behind the front teeth to the back of the palate
- an incomplete cleft palate: affecting just the back of the palate, near the back of the throat
A cleft palate is harder to see than a cleft lip. Doctors find them when they examine the inside of a baby's mouth after birth.
Read more about cleft palate.
Cleft Palate With Cleft Lip
A cleft palate with a cleft lip is when a baby's lip and palate (roof of mouth) both do not form properly during pregnancy. How serious the defects are can vary depending on the type of cleft lip and the type of cleft palate.
For instance, one baby might be born with:
- An incomplete cleft palate with an incomplete unilateral cleft lip: The baby has a cleft on one side of the lip only that does not extend to the nostril, and a cleft in the roof of the mouth that does not go all the way to the back of the palate.
But another baby might have:
- A complete cleft palate with a complete bilateral cleft lip: the baby has clefts on both sides of the lip that reach the nostrils and a cleft in the roof of the mouth that goes all the way back.
Read more about cleft palate with cleft lip.
What Causes Clefts?
During the first 6 to 10 weeks of pregnancy, the bones and tissues of a baby's upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. A cleft happens when parts of the lip and mouth do not completely fuse together.
Doctors don't always know why a baby develops cleft lip or cleft palate. But many clefts are thought to be due to:
- Genetics: Mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.
- Things that happen during pregnancy: Some medicines (such as some anti-seizure medicines) can increase a pregnant woman's chances of having a baby with a cleft lip or palate. Also, babies of moms who don't enough prenatal nutrients (for example, folic acid) may be at risk for a cleft. Pregnant women who smoke cigarettes, use drugs, or drink alcohol also increase their baby's risk for birth defects. Binge drinking (drinking four or more drinks in a short period of time) during the first weeks of pregnancy increases a baby's risk for a facial birth defect like a cleft lip or cleft palate.
What Problems Can a Cleft Cause?
Clefts can affect many actions of the mouth and face. Children born with clefting might have issues related to their feeding, hearing, teeth, and speech.
Babies with a cleft lip only usually don't have feeding problems. Feeding can be a bigger challenge when the palate has a cleft:
Normally, the palate prevents food and liquids from entering the nose.
A cleft palate:
- causes babies to swallow a lot of air and regurgitate food into the nose
- makes it harder for babies to latch on and suck during breastfeeding or formula feeding
So a baby with a cleft palate may need a special nipple and bottle to receive pumped breast milk or formula. Breastfeeding moms might want to talk with a lactation consultant, who can offer help and suggestions.
Babies with feeding issues should be seen regularly by a doctor to make sure that they're gaining weight well.
Middle Ear Fluid Buildup and Hearing Loss
Many children with cleft palate are at risk for fluid buildup in the middle ear. This fluid can't pass through the Eustachian (yoo-STAY-shun) tube as it should, which can lead to ear infections and even hearing loss. So kids with cleft palate usually need ear tubes placed in their eardrums to help drain the fluid and improve hearing.
Kids with cleft palate should have their ears and hearing checked once or twice a year, or more if they are having hearing problems.
Children with a cleft lip and palate often have dental problems. These can include:
- small teeth
- missing teeth
- extra teeth (called supernumerary)
- teeth that are out of position
- a defect in the gums or alveolar ridge (the bone that supports the teeth). Ridge defects can displace, tip, or rotate permanent teeth or prevent permanent teeth from coming in properly.
Kids with cleft lip and palate can have more dental problems than other kids. They should see a pediatric dentist who specializes in cleft lip and palate regularly and brush and floss every day. The dentist will check a child's mouth growth and development, identify any problems, and make treatments when needed.
Kids with cleft lip and palate may begin orthodontic treatment as early as 6 years of age. It may start with palatal expansion, a process that makes the width of the palate normal. Later, it may involve braces to position the teeth.
Some kids with a cleft might be missing a permanent tooth, which can be replaced with a removable appliance or, in early adulthood, a dental implant.
Kids with cleft lip have fewer speech problems than those with cleft palate. With a cleft, the soft palate is too short and air escapes through the nose when the child speaks, so some kids' voices sound nasal. Even after cleft palate repair surgery, some kids may still sound nasal.
Children with clefts also can have other types of speech problems — for example, saying "wed" instead of "red." Sometimes, the dental problems associated with the cleft will distort some sounds, particularly "s," "sh," "ch," and "j."
A speech-language pathologist can check a child's speech and language skills and recommend treatment if needed.
How Are Clefts Treated?
Treatment depends on the type of cleft. Your pediatrician will work with a team of health care professionals to meet your family's needs. As your child gets older, the team will help with his or her move to adult health care.
Besides the pediatrician, the treatment team will include:
- plastic surgeon
- ear, nose, and throat (ENT) physician (otolaryngologist)
- oral surgeon
- speech-language pathologist
You might also work with a:
- social worker
- psychologist or therapist
- team coordinator
Your child might see the care team a few times a year. The team coordinator will help organize the visits. The team will work with your doctor on the treatment plan.
How Can I Help My Child?
Most kids with cleft lip or cleft palate are treated successfully with no lasting problems. But it can be hard when they miss school for doctor's appointments, or when speech problems make it hard for them to communicate well. In spite of these and other social, psychological, and educational challenges, kids with clefts just want to be treated like everyone else.
Children may face teasing and bullying because of how a cleft looks. If your child is teased, talk about it and be a patient listener. Try to give your child tools to confront teasers. Find out what your child would like to say to them and practice it together.
The psychologists and social workers on the treatment team are there for you and your child. So turn to them to help guide you through any hard times. You also can find more information and support online:
- American Cleft Palate-Craniofacial Association (ACPA)
- Cleft Lip & Palate Association
- FACES: The National Craniofacial Association
- Smile Train