If you’ve had a baby who has been affected by a cleft lip or palate, you might be wondering whether it increases the chances of having another baby with the same condition. Your baby might have been diagnosed with a cleft lip and palate, following an ultrasound during pregnancy, or diagnosed shortly after birth.

It can be upsetting to know that your child will be born with a birth defect, but the more information you have on the condition, the more prepared you’ll feel when the time comes.

This article will tell you everything you need to know about cleft lip and palate.

Cleft lip definition

Cleft lip and cleft palate are both congenital birth defects. A congenital birth defect refers to something that is present at birth. Cleft lip and cleft palate are the most common cranio-facial anomalies, which means abnormalities that affect the skull and face.

The word ‘cleft’ means ‘split’ or ‘break’. Cleft lips occur during pregnancy when the tissues that make up the lip don’t join completely before birth. This results in an opening in the upper lip on one or both sides. The opening can vary in size. It might appear as a small slit in the upper lip; sometimes it can be large and extend from the lip to the nose.

There are different types of cleft lip:

Unilateral cleft lip, which affects one side of the lip
Bilateral cleft lip, which affects both sides of the lip
Complete cleft lip, where the cleft affects the lip and goes into the nose
Incomplete cleft lip, which might appear as just a small notch in the lip and doesn’t involve the full thickness of the lip tissue.

Cleft palate definition

A cleft palate occurs during pregnancy, when the tissues that make up the roof of the mouth do not join completely before birth, leaving a gap in the roof of the mouth.

This can affect either the soft palate (towards the throat) or the hard palate (towards the lips). For some babies with cleft palate, both the soft and the hard palate are affected.

A submucous cleft palate (or SMCP) is a gap in the palate that is covered by the tissues of the roof of the mouth, so doesn’t appear to be open. This type of cleft palate might not be diagnosed until later in life, usually if there are feeding or speech problems.

What causes cleft lip and palate?

The exact cause of cleft lip and palate is mostly unknown, but it’s thought to be a combination of both genetic and environmental factors coming together; therefore, these conditions cannot be predicted or prevented. They are unlikely to be caused by anything that you did or didn’t do during pregnancy.

Some babies inherit a gene that could make it more likely, This, combined with environmental factors causes the cleft lip and palate to develop.

How common are cleft lip and palate?

According to research, birth defects affect approximately 3-5% of all births in the United States.

Research suggests the prevalence of cleft lip and palate in the U.S are as follows:

Approximately 1 in every 1600 babies are born with cleft lip with cleft palate
Approximately 1 in every 2800 babies are born with cleft lip (without cleft palate)
Approximately 1 in every 1700 babies are born with cleft palate (without cleft lip).

Orofacial clefts often occur in isolation; this means they aren’t linked to other birth defects or conditions. However, cleft lip or cleft palate are sometimes associated with genetic conditions or syndromes.

Can you have cleft lip without a cleft palate?

It’s possible for your baby to be born with a cleft lip without a cleft palate. It’s possible to have either one without the other.

Your baby might have a cleft lip, a cleft palate, or a cleft lip and palate. A cleft palate on its own is known as an isolated cleft palate.

Risk factors – cleft lip and palate

Some factors in pregnancy make it more likely for cleft lip and palate to occur.

They are:

Smoking – Research suggests orofacial clefts are more common in babies whose mothers smoke during pregnancy
Certain medications – for example, medications used for epilepsy
Pre-pregnancy diabetes. Women with this condition have an increased risk of having a baby with cleft lip, with or without cleft palate, compared with non-diabetics
Gender. Cleft lip is more common in males. Boys are twice as likely as girls to have a cleft lip, with or without a cleft palate. Girls are more likely than boys to have cleft palate without a cleft lip.
Genetics. Babies with a family history of cleft lip and cleft palate are at increased risk
Obesity. Evidence suggests babies born to obese mothers are at increased risk.

When does cleft lip develop in pregnancy?

Cleft lip and cleft palate develop in early pregnancy as the tissues of the baby’s lips, mouth and palate form, between weeks 4 and 9 of pregnancy.

If these tissues don’t form completely and come together at this stage, a cleft will develop.

A cleft will develop within the first 3 months of pregnancy.

Related reading: What To Avoid During The First Trimester.

Can cleft lip be detected on ultrasound?

Cleft lip can be detected on ultrasound but not every time. Cleft palate is unlikely to be detected on ultrasound.

Although cleft lip and cleft palate can be picked up on ultrasound, it’s common for them to be detected for the first time at birth. Ultrasound technology enables us to screen for many things but it has limitations and not everything can be seen on a scan.

A cleft lip is unlikely to be detected on a first trimester or 12 week scan. It’s likely to be detected on a second trimester or anomaly scan, usually performed at 18-20 weeks.

Associated problems with cleft lip and cleft palate

Children with a cleft lip or palate are likely to face some challenges, particularly in the early days, weeks and months following birth, prior having surgery (if needed).

Common problems are:

Feeding problems. A baby with a cleft lip and palate might find it difficult to breastfeed or feed from a normal bottle. The condition makes sucking difficult as babies cannot form a good seal with their mouth
Language development delay or speech problems. If not repaired, a cleft palate cause a child to have speech problems, such as unclear or nasal sounding speech
Hearing problems or ear infections. Some babies with a cleft palate are at increased risk of ear infections due to fluid build up in the middle ear. To prevent this, babies might need special treatment to aid fluid drainage and will need regular hearing checks
Dental problems and oral health. If the cleft extends through the upper gum line it can prevent permanent teeth from appearing, or permanent teeth will be misshapen. Sometimes children can also have missing teeth. This creates overcrowding in the mouth and higher risk of tooth decay. Routine dental care will be important to ensure your baby develops healthy teeth and avoids or minimises dental problems.

A baby diagnosed with a cleft lip and palate will be referred to specialist teams to help with feeding, speech therapy, dental and orthodontic care, and to an oral or plastic surgeon.

Many of these problems will be greatly reduced following either cleft lip repair or cleft palate repair.

Can you breastfeed a cleft palate baby?

It might be possible to breastfeed or feed your baby breast milk if she has cleft lip or palate. However, it can be challenging, as it affects her ability to suck effectively, and for the lips and mouth to form a good seal at the breast – or teat, if you’re using a bottle.

If you know your baby will be born with a cleft lip or cleft palate, it’s advisable to find an experienced lactation consultant or to ask your care team to refer you to one in advance, so you can be well prepared.

It might also be a good idea to try Expressing Colostrum During Pregnancy, in preparation for your baby’s arrival.

For more information read our article Breastfeeding A Baby With A Palate And/Or Lip.

Does cleft palate affect speech and language development?

It’s common for children with a cleft palate to have some speech problems. It’s also common for them to experience delays in speech development or the formation of speech sounds. Some children will need input from a speech and language therapist (SALT); most, however, will go on to develop normal speech by the age of 5.

Typically, children born with only a cleft lip will not go on to develop speech problems.

Speech problems occur in infants with cleft palate as there is too much air leaking from the nose during speaking. This can result in what’s known as nasal speaking.

Speech and language therapy can begin even before your child starts talking; it can prevent them from making speech compensations. Speak to your child’s care provider for a referral.

How are cleft lip and palate treated?

Knowing your child has, or will be born with, a visible birth defect can be distressing. With treatment, however, most children will go on to live healthy lives without any major health concerns.

Treatment will vary, depending on the type and severity of the cleft but also on the age and needs of your child. Many babies born with a cleft can have surgery early in life to repair cleft lip and palate.

At what age is cleft lip and palate repaired?

Cleft lip repair is usually performed in your child’s first year of life, ideally at 3-6 months of age. Cleft lip and palate repair is usually performed a little later, at 6-12 months, but can be performed up to 18 months.

Cleft lip surgery

Cleft lip repair is done under general anaesthetic, meaning your baby will be asleep during the surgery. The operation itself will usually take 1-2 hours to complete; the cleft in your baby’s lip will be brought together with stitches.

Your baby will need to remain in hospital for a day or two following surgery. The stitches in the upper lip will either need to be removed after a few days, or they will dissolve on their own.

The baby will be left with a small scar above the upper lip, which will fade, with time.

Cleft palate surgery

Surgery to repair a cleft palate is also performed under general anaesthetic while the baby is asleep; it takes around 2 hours. During the surgery, the gap in the roof of the mouth is closed and the muscles and tissues of the hard and/or soft palate are rearranged.

Your child will need to stay in hospital for a few days after the operation. The stitches will be dissolvable and the scar will not be visible outwardly, as it will be inside the mouth.

After either surgery, your child will mostl likely need input from various specialities and follow up assessments, to track health developments.

Additional surgeries

Some children who undergo cleft lip and cleft palate surgery might require further surgeries later in life.

Additional surgery might be required to:

Repair a cleft in the bony upper gum, using a piece of bone. This is known as a bone graft and is usually done when your child is 8-10 years old. This might be needed to fill in the upper gum line, to support permanent teeth and stabilize the upper jaw
Improve the appearance or function of your baby’s upper lip or palate, following the original surgery, if it either did not heal well or there are ongoing speech problems
Improve the shape of your baby’s nose
Improve the shape of the jaw.

How can I prevent a cleft lip and palate?

It’s natural to want to protect our babies and prevent potential complications or birth defects, if possible. If you’ve had a baby with a cleft lip or palate, you might be wondering what are the chances of it happening again in a future pregnancy.

Most incidences of clefts are one-off, so it’s unlikely you’ll have another child with the same problem. However, if you’ve had one child with a cleft lip or palate, your chances of having another are slightly higher – at 2-8%.

As the exact cause of cleft lip and cleft palate remains unknown, it’s impossible to prevent it completely. However, there are things you can do, to minimise the chances of common birth defects occurring.

Common pregnancy advice suggests you should:

Take prenatal vitamins, including folic acid
Maintain a well balanced diet
Avoid alcohol or tobacco use in pregnancy
Discuss any medications with your care provider
Speak to a genetic counsellor if you or your partner are known to carry a gene for a specific genetic condition.

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