Cleft lip and cleft palate are birth abnormalities of the mouth and lip. In the Untied States, nearly 6,800 babies are born with oral-facial clefts annually. These abnormalities occur less frequently among African-Americans. Cleft lip and cleft palate occur early in pregnancy when the sides of the lip and the roof of the mouth do not fuse together as they should. A child can have cleft lip, cleft palate, or both. Cleft lip and cleft palate together are more common in boys. It is also important to know that most babies born with a cleft are otherwise healthy with no other birth abnormalities.
Cleft lip and cleft palate may occur together in an infant, or separately. The degree of the abnormality of both cleft lip and cleft palate can vary greatly. The most common early problem associated with these abnormalities is feeding your baby.
The exact cause of cleft lip and cleft palate is not completely understood. Cleft lip and/or cleft palate are caused by multiple genes inherited from both parents, as well as environmental factors that scientists do not yet fully understand. When a combination of genes and environmental factors cause a condition, the inheritance is called "multifactorial" (many factors contribute to the cause). Because genes are involved, the chance for a cleft lip and/or cleft palate to happen again in a family is increased, depending on how many people in the family have a cleft lip and/or cleft palate. If parents without clefts have a baby with a cleft, the chance for them to have another baby with a cleft ranges from 2 to 8 percent. If a parent has a cleft, but no children have a cleft, the chance to have a baby with a cleft is 4 to 6 percent. If a parent and a child have a cleft, the chance is even greater for a future child to be born with a cleft. Genetic consultation is suggested.
The symptoms of these abnormalities are visible during the first examination by your infant's physician. Although the degree of the abnormality can vary, upon inspection of the mouth and lips, the abnormality can be noted, as there is an incomplete closure of either the lip, roof of the mouth, or both.
Beyond the cosmetic abnormality, there are other possible complications that may be associated with cleft lip and cleft palate, including the following:
The most immediate concern for a baby with cleft palate is good nutrition. Sucking for children with a cleft palate is difficult because of the poorly formed roof of the mouth. Children with just a cleft lip (without a cleft palate) do not routinely have feeding difficulties. The following are suggestions to help aid in the feeding of your infant:
In some cases, supplements may be added to breast milk or formula to help your infant meet his/her calorie needs. Consult your child's physician regarding other home devices (i.e., small paper cups) for feeding your child with a cleft palate.
There may be many people involved in management of a cleft abnormality for your child, because the skills of many different areas are needed to help with the problems that can occur with cleft abnormalities. The following are some of the members of the team:
Treatment for these abnormalities includes surgery and a complete team approach to help with the multiple complications that can occur. Specific treatment will be determined by your child's physician based on:
For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). This will be decided by your child's surgeon. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 6 to 18 months. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child's physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.
At your first visit with the plastic surgeon, he/she will discuss with you the details of the surgery, risks, complications, costs, recovery time, and outcome. At this time, your child's surgeon will answer any questions you may have.
After the surgery for cleft lip:
Your child may be irritable following surgery. Your child's physician may prescribe medications to help with this. Your child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site.
Stitches will either dissolve on their own or will be removed in approximately five to seven days. Specific instructions will be given to you regarding how to feed your child after the surgery. The scar will gradually fade, but it will never completely disappear.
During the surgery, and for a short time after surgery, your child will have an intravenous catheter (IV) to provide fluids until he/she is able to drink by mouth. For a day or two, your child will feel mild pain, which can be relieved with a non-aspirin pain medication. A prescription medication may also be given for use at home.
Your child's upper lip and nose will have stitches where the cleft lip was repaired. It is normal to have swelling, bruising, and blood around these stitches.
After the surgery for cleft palate:
This surgery is usually more involved and can cause more discomfort and pain for the child than cleft lip surgery. Your child's physician may order pain medicine to help with this. As a result of the pain and the location of the surgery, your child may not eat and drink as usual. An intravenous (IV) catheter will be used to help give your child fluids until he/she can drink adequately.
A small amount of water should be offered after every bottle or meal to cleanse the incision. You can continue to rinse this area gently with water several times a day, if necessary.
Diet after surgery:
Your child's physician may allow breastfeeding, bottle-feedings, or cup-feedings after surgery. Your child should be placed on a soft diet for seven to 10 days after surgery. For older infants and children, age-appropriate soft foods may include strained baby foods, popsicles, yogurt, mashed potatoes, and gelatin. Note: your child should not use a straw or pacifier, as both could damage the surgical repair.
Activity after surgery:
Your child can walk or play calmly after surgery. He/she should not run or engage in rough play (i.e., wrestling, climbing) or play with "mouth toys" for one to two weeks after surgery. Your child's physician will advise you when your child can safely return to regular play.
Follow-up with your child's surgeon and the cleft team is very important. This will be discussed with you. Your child's physician will also be an important part of the child's overall health management after the surgery.
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