Clinical Reference Systems: Pediatric Advisor 10.0
Cleft Lip and Cleft Palate
What is a cleft lip or palate?
The term "cleft" refers to an opening. An opening in the
lip is called cleft lip. An opening in the roof of the
mouth (palate) is called cleft palate.
The separate parts that form a baby's face and palate come
together during early pregnancy. A cleft occurs if the
parts do not fuse completely.
One out of every 700 babies has some form of cleft lip or
cleft palate. Up to 5,000 babies are born with a cleft lip
or palate in the United States each year.
Cleft lip used to be referred to as a hare lip because it
was thought the upper lip looked like a rabbit's lip. The
term hare lip should not be used. The defect should be
referred to as cleft lip.
What is the cause?
At one time people thought that if a pregnant woman had bad
or frightening thoughts, or if she encountered gypsies or a
fish with a gaping mouth, she would have a baby with a
cleft. We now know these stories are not true.
There is no single cause for cleft lip or cleft palate.
A cleft can occur without a known reason. Sometimes factors
such as disease, drugs, and alcohol can act on the
developing fetus and result in a cleft.
Heredity can play a role in causing clefts. If either
parent has a cleft, the chances increase that the baby will
have a cleft. If both parents are normal and have a baby
with a cleft, the chances that they will have another baby
with a cleft increase.
Many children with clefts have other problems and defects as
well. They may grow more slowly or have learning
difficulties. Sometimes clefts are associated with
hereditary diseases that the family may be unaware of.
Therefore, it is very important for your baby and you to see
a specialist in genetics (a geneticist). The geneticist can
help explain the cause of the cleft lip or palate and
determine your chances of having another baby with a cleft.
How do clefts affect a baby's face?
There may be a cleft on one side of the upper lip or on both
sides. The split sometimes occurs only on the lip, but at
times it may extend up into the nose as well. In the case
of a cleft palate, the soft part of the palate at the back
of the mouth may be involved, or the cleft may extend
forward to the bony part of the palate called the hard
palate. A baby may have a cleft lip or a cleft palate or
How is it treated?
You probably have many questions about what can be done for
your baby. The best approach for the treatment of your baby
is a team approach. A team of professionals including
doctors, speech therapists, audiologists, psychologists, and
others will help take care of your baby.
You probably met your pediatrician and surgeon while your
baby was in the newborn nursery. Your pediatrician will
provide you with general pediatric care and coordinate all
the services that your baby may need. The surgeon may have
been able to stitch your baby's lip before sending the baby
home with you. If your baby has a cleft palate, it may be
surgically repaired at a later date, depending on the
judgment of your surgeon.
Another doctor needed in the evaluation, treatment, and
follow-up of your baby is an ear, nose, and throat
specialist (otolaryngologist). Babies with cleft lip and
cleft palate usually have middle ear problems, which cause
fluid buildup in the middle ear.
Your baby's teeth can be affected if the cleft is in the
gum. Dentists, specifically an orthodontist and a
prosthodontist, may need to evaluate and monitor your baby's
There are many special problems related to cleft lip and
cleft palate that may require attention:
- Problems with feeding
Often a parent's first concern is, "How will I feed my
baby with a cleft lip and palate?" For example, the
cleft can make effective sucking difficult and the milk
may come back through the baby's nose. However, your
baby will thrive when you learn to feed her effectively.
A speech and feeding therapist can help you. You will
be taught ways to feed your baby, such as holding her in
an upright position, giving small amounts of milk, and
using a syringe or a nipple with a large hole.
- Problems with speech
Difficulties in speech may occur for many reasons. The
quality of speech is often nasal and certain consonant
sounds may be difficult for your baby to make because
air leaks through the nose. Therefore, your baby needs
to be under close supervision of a speech and language
- Problems with hearing
Your baby may have many more ear infections than a baby
without a cleft. Difficulties in swallowing affect air
pressure in the middle ear and spread infection through
the nose to the ears. An audiologist and an ear, nose,
and throat specialist will need to monitor your child's
hearing closely because frequent ear infections may lead
to hearing loss.
You may wonder where you can find a team of professionals
for your baby. Your pediatrician is the best resource.
There are many treatment centers for cleft lip and cleft
palate throughout the United States and Canada. They are
referred to by many different names, such as cleft treatment
centers, congenital defect clinics, or craniofacial clinics.
You may obtain more information about these centers and
additional information on cleft lip and cleft palate by
contacting one of the organizations listed below.
The American Cleft Palate Educational Foundation
331 Salk Hall
University of Pittsburgh
Pittsburgh, PA 15261
99 Crowns Lane, Third Floor
Toronto, ON Canada M5R 3P4
1002 Liberty Lane
Warrington, PA 18976
FACE of Sarasota, Inc.
P.O. Box 1424
Sarasota, FL 34230
National Association for the Craniofacially Handicapped
P.O. Box 11082
Chattanooga, TN 37401
Hemifacial Microsomia/Goldenhar Syndrome Family Support Network
Cynthia Fishman, R.N., and Richard Fishman
84 Gleniffer Hill Road
Richboro, PA 18954
International Craniofacial Foundation
10210 North Central Expressway
Suite 230 LB37
Dallas, TX 75231
(800) 535-3643 or (214) 368-3590
Let's Face It
P.O. Box 711
Concord, MA 01742
National Foundation for Facial Reconstruction
317 East 34th Street, Ninth Floor
New York, NY 10016
(800) 422-FACE or (212) 263-6656
American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852