Patient education: Cleft lip and cleft palate (The Basics)

What are cleft lip and cleft palate? — Cleft lip and cleft palate are kinds of birth defects. A cleft lip is an opening or split in the upper lip. A cleft palate is an opening or split the roof of the mouth (called the palate). A baby can be born with one or both of these conditions.

What are the symptoms of cleft lip and cleft palate? — Some babies with a cleft lip have a small notch in their upper lip. Others have a larger opening or hole that goes all the way to the bottom of their nose (figure 1).

A cleft palate can be in the front or back of the roof of the mouth, on one or both sides.

Babies with these problems can have trouble nursing or drinking from a regular bottle. They might need to use a special bottle.

Is there a test for cleft lip and cleft palate? — In some cases, a cleft lip can be seen on an ultrasound, an imaging test doctors use to check on the baby during pregnancy. An ultrasound creates pictures of the baby inside the uterus.

It is more difficult to see a cleft palate on an ultrasound.

If an ultrasound shows that your baby has a cleft lip or palate, the person doing the ultrasound will check the baby for other birth defects. Your doctor or midwife might suggest a test called "amniocentesis." During amniocentesis, a doctor puts a needle into the mother's uterus and removes some of the fluid that is around the baby. The fluid is then tested to check for problems with the baby's genes.

Doctors also check for cleft lip and palate after a baby is born. This involves looking in the baby's mouth but also using a finger to feel the palate. That's because in some cases, you can't tell a baby has a cleft palate just by looking.

How are cleft lip and cleft palate treated? — Most of the time, surgery can fix a cleft lip and a cleft palate. For cleft lip, doctors usually do surgery in the first few months of life, or at least before the child turns 1 year old. For cleft palate, doctors should do surgery before the child is 18 months old. But the timing of the surgery is different for every child. And some children might need more than 1 surgery.

Will my child have problems as he or she grows up? — Your child might need other surgeries as he or she grows. Even after surgery, children with cleft lip or cleft palate might have other problems, including:

●Missing, extra, or crooked teeth – Many children need braces after their permanent teeth grow in.

●Trouble speaking – Some children need to work with a speech therapist to help them learn to speak clearly.

●Ear infections and hearing loss – For children who get many ear infections, the doctor might suggest placing a small tube in the eardrum. These tubes help prevent ear infections and might help the child hear better.

Can cleft lip and cleft palate be prevented? — It's not always possible to prevent a cleft lip or cleft palate. Some babies are just born with it. But women might be more likely to give birth to a child with one of these problems if they do certain things during pregnancy, including:

●Take certain medicines, such as:

•Medicines used to treat seizures

•Methotrexate, which is used to treat cancer and other diseases

●Smoke cigarettes

●Drink alcohol

●Not get enough "folic acid," a type of vitamin

Women who are pregnant or planning to get pregnant should take a "prenatal" multivitamin that has at least 400 micrograms of folic acid. They should not smoke or drink alcohol. They should also tell their doctor about any medicines they are taking.

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Patient education: How to plan and prepare for a healthy pregnancy (The Basics)