Cleft lip and Cleft Palate
Cleft means 'split' or 'separation'. During early pregnancy separate areas of the face develop individually and
then join together. The lip usually closes by 5 to 6 weeks after conception, and the palate by 10 weeks. If some
parts do not join properly, the result is a cleft. The cleft will vary in both type and severity. Cleft lip and
cleft palate comprise the fourth most common birth defect in the United States. One of every 700 newborns is
affected by cleft lip and/or cleft palate.
What is a Cleft Lip?
A cleft lip is an opening in the upper lip between the mouth and nose, which occurs when proper fusion does
not take place. It can range from a slight notch in the colored portion of the lip to complete separation in
one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft.
If a cleft occurs on both sides it is called a bilateral cleft.
A cleft lip separation may include a separation of the bones of the upper jaw and/or upper gum. This may
range from a small notch in the gum to a complete division of the gum into separate parts.
What is a Cleft Palate?
A cleft palate is an opening in the roof of the mouth in which the two sides of the palate did not fuse, or
join together by the 10th week of development. The back of the palate (towards the throat) is called the soft
palate and the front (towards the mouth) is known as the hard palate. If you feel the inside of your mouth with
your tongue, you will be able to notice the difference between the soft and the hard palate.
A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation
of the roof of the mouth (soft and hard palate).
What causes a Cleft Lip or Cleft Palate?
Although a complete understanding of why cleft lips or cleft palates occur is not known, there appears to be
an association with a combination of genetic and environment factors.
Genetic risk factors depend on the number of affected people in a family, the closeness of affected
relatives, and the severity of the clefts. Keep in mind that sometimes clefts run in families, and sometimes a
baby will be born with a cleft without anyone else in the family having one.
Are there any treatments for Cleft Lip or Cleft Palate?
Cleft lips and cleft palates are usually treated through a combination of surgery, dental, and orthodontic
care. This continuum of care provided by interdisciplinary cleft palate and craniofacial healthcare providers
is usually provided over a number of years focusing on complete rehabilitation. Speech therapy is often a
complementary part of this continuum of care.
Breastfeeding the baby with Cleft lip and/or Cleft Palate
Regardless of the severity, your baby will be able to receive all of the benefits of breastfeeding with some
adjustments to methods and positioning. Every mom is concerned that her baby will get enough nutrition for
growth and development, that she will enjoy bonding with her baby and that her baby can use the muscles of his
or her mouth to feed and speak at the same rate of other babies. You will be introduced to a team of lactation
consultants, craniofacial specialists, & speech pathologists that will provide education, support,
equipment and resources to help you and your baby enjoy a positive breastfeeding experience. Your baby will be
able to wean, enjoy new foods, and speak at the normal stages of development.
- What if my baby has a cleft lip?
If your baby has a cleft lip he or she should be able to breastfeed with minimal adjustments. Your baby may
experience a little trouble forming an airtight seal around the nipple. Even with out a cleft lip, some
babies need a little time to figure this out. With a little more attention given to proper positioning, you
and your baby will be able to enjoy the breastfeeding experience.
- What if my baby has a cleft lip on both sides?
If your baby has a cleft lip on both sides it may be more difficult to breastfeed. Your team of specialists
may fit a mouth piece in preparation for surgery which will help. It may be necessary to use a special
squeeze bottle which you press as your baby sucks. After surgery you will be encouraged to breastfeed to
help comfort the baby, promote healing and help the baby adjust to breastfeeding.
- What if my baby’s cleft is narrow and limited to the soft palate?
If your baby's cleft is narrow and limited to the soft palate, he or she should be able to use the front
part of the hard palate to suck the nipple. In some cases he or she may need supplementary feedings from a
squeeze bottle with expressed breast milk.
- What if my baby has a cleft lip and a cleft soft and hard palate?
If your baby has a cleft of the lip and the soft and hard palate your baby may be unable to suck from your
breast. Because your baby has an opening between the nose and mouth, they can not create enough pressure to
suck effectively. They usually feed successfully with bottles and mouth pieces designed for babies with
clefts. Many pumps are available that allow you to drive, use the computer, read and perform other daily
tasks while you express milk (more information below). During feedings you will find that holding your baby
in a more upright position, burping often, and allowing plenty of time for a feeding will reduce some of
the common feeding problems like nasal regurgitation where milk comes out through the nose. Though, breast
milk is not irritating to the mucus membranes, nasal regurgitation makes it more difficult to tell how much
the baby is getting and can make feedings more difficult.