Cleft lip and cleft palate describe an abnormal gap in either the upper lip or the roof of the mouth (the palate). It occurs when some parts of the mouth fail to join together during early pregnancy. The lip and palate develop separately, which means it is possible for a baby to be born with only a cleft lip, only a cleft palate, or a combination of both.

Clefts that occur only on one side are called unilateral clefts. When the cleft affects both sides, it is called a bilateral cleft.

Cleft lip and cleft palate can occur by themselves, or in some cases along with other problems. Most of the time, cleft lip or cleft palate is detected during routine scans in pregnancy.

What causes cleft lip and cleft palates?

Often the cause of a cleft lip and palate is unknown. Sometimes it can happen because there is a family history of the condition. However, sometimes a child is born with the condition when there is no family history and no known cause of the condition.

Treatment

The treatment required for a child with a cleft lip or cleft palate depends on the diagnosis at birth. A cleft lip may need only one operation in the first year of life. A child with a large cleft involving the lip and palate will need several operations. Your child's surgeon will explain your child's surgical plan to you.

Your child will usually only need to stay in hospital for one to three days for surgical procedures.

Depending on their needs, your child may need to have ongoing care from a cleft team. This might include a/an:

• clinical nurse consultant
• audiologist
• dental specialist
• ear, nose and throat (ENT) surgeon
• oral and maxillofacial surgeon
• paediatrician
• plastic surgeon
• speech pathologist

Your child will see the cleft team from birth until their face has finished growing (usually in their late teens).

How a cleft lip and palate affects children

Your child may be affected in a number of ways by a cleft lip and/or palate, and there are a number of important areas to consider in their care.

Hearing

Children affected by cleft palate are more likely to have hearing problems and fluid in the middle ear.

• Every baby with a cleft palate needs to have their hearing monitored closely by a hearing specialist (audiologist).  A hearing assessment should be arranged for when your baby is around four weeks old, and repeated again around 12 weeks of age.
• Annual hearing tests are recommended during early childhood for children with a history of cleft palate.

Speech

The palate is very important for speech, therefore some children with a cleft palate might have difficulty talking even after palate repair. Children with a cleft lip but not a cleft palate shouldn't have any speech issues related to their cleft.

• Children with a cleft palate may have trouble pronouncing consonants (p, b, t, d, k, g, f, v, s, z, sh, ch) and they may have a nasally sounding voice
• They may also make unfamiliar sounds, which make it difficult to understand what your child is saying. This can be very frustrating to the child
• Prior to palate repair, your child should be babbling (e.g. mama, nana) and playing with sounds (e.g. blowing raspberries and kisses), however they may only make a few different sounds until the palate is repaired. Depending on the age of your child when their palate is repaired, they may not yet be using words
• For more information on how to encourage your child's speech and language development, you can watch the "Supporting Early Communication for Children with Cleft Palate" webinar below
• After surgery, some children may need speech therapy to help eliminate unusual speech errors related to the cleft and to develop the sounds your child needs for speech 

 You will contacted by the Speech Pathology team when your child is 18 months old to monitor their speech and language development.

Teeth

Many children with a cleft of the lip and palate will have missing teeth, particularly in the line of the cleft.

They may also have extra teeth, misshapen or malformed teeth. Because of this, their teeth can be crowded, tilted or rotated.

• As for any child, children with a cleft should be seen regularly by a dentist to ensure that their teeth are looked after carefully. It is a good idea for children born with a cleft to start seeing a dentist who is comfortable looking after children. Ideally the first dental visit should occur shortly after their first teeth come through and certainly by the age of 18 months.
• Healthy teeth and gums and a positive attitude to going to the dentist are all important for your child's long term care. It is likely that they will want to have braces or other dental treatment in the future to improve their appearance, and healthy teeth are essential for this.

Feeding

For information on feeding a baby with cleft lip, palate or both, see our fact sheet Cleft lip and palate – infant feeding.

Key points to remember

• Cleft lip and palate are an abnormal gap in the upper lip or the roof of the mouth.
• Cleft lip and cleft palate affect infant feeding, hearing, speech and teeth.
• Your child will need hearing tests, and monitoring by a dentist and speech pathologist experienced in cleft care.
• A child born with cleft lip and cleft palate will require several operations to repair the cleft.
  

For more information

• Kids Health Info fact sheet: Cleft lip and palate – infant feeding
• The Royal Children's Hospital: Cleft lip booklet
• The Royal Children's Hospital:  Cleft palate booklet
• The Royal Children's Hospital:  Cleft lip and palate: Infant feeding booklet
  
• The Royal Children's Hospital: Department of Plastic and Maxillofacial Surgery
• The Royal Children's Hospital: Department of Speech Therapy
• Parent support group: CleftPALS Victoria, ph 0425 784 130 (general support)
• See your cleft coordinator or GP.

Developed by The Royal Children's Hospital Speech Pathology and Plastic and Maxillofacial Surgery departments. We acknowledge the input of RCH consumers and carers.

Reviewed August 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.