Cleft Lip and Palate

Cleft lip and cleft palate are birth defects that can affect the upper lip and the roof of the mouth. Learn more about the health and nutrition implications for children with cleft lip/cleft palate,

Cleft Lip

In the case of cleft lip, a split is left in the tissue of the upper lip that can affect only the lip or extend beyond the lip as far as the nose. The cleft can be on one side of the lip (unilateral) or on both sides (bilateral).

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Cleft Palate

In cleft palate, the growth plates that form the roof of the baby’s mouth fail to close, leaving a crack or opening. The cleft can occur in either the hard palate which is the bony roof of the mouth, the soft palate which is the soft tissue towards the back of the roof of the mouth, or both the hard and soft palates.

Cleft lip and cleft palate can occur separately or together.

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Complications

Problems that may be present because of a cleft lip or palate are:

  • Feeding difficulties
  • Failure to gain weight
  • Flow of milk through the nose during feeding
  • Dental problems, such as missing, extra, malformed, displaced, and crooked teeth, and cavities
  • Poor growth
  • Frequent ear infections
  • Speech difficulties, including poorly pronounced sounds and/or air escaping from the mouth into the nose when speaking
  • Change in the shape of the nose

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Causes

There are many causes of cleft lip and palate, often a combination of genetic and environmental factors.

Genetic Factors

A family history of cleft lip or palate, although not always present, can increase the chance of a baby being born with cleft lip and palate.

Environmental Factors

Risk factors for cleft lip and palate include viruses, toxic substances, environmental pollutants, and nutritional imbalances.

Cleft lip and palate may occur alone or in conjunction with other syndromes or birth defects.

About 1 out of 700 -1000 people are born with cleft lip and/or cleft palate, making it one of the most common major birth defects. More boys than girls have a cleft lip, while more girls have cleft palate without a cleft lip. There is a slightly higher occurrence of cleft palate/lip in children of Asian, Latino or Native American descent.

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Treatment

Ideally, children with cleft lip and/or palate should be followed from birth through adolescence by a craniofacial team who designs an individualized treatment plan. A team might include a surgeon, a dentist, a speech-language pathologist, and a dietitian, among others.

Treatment can include the following:

  • Surgery: Surgical procedures can correct cleft lip and palate. Several surgeries may be required as the child grows. A typical schedule for surgery is 3 months of age: lip repair; 12 months of age: palate repair; 5 years: lip revision.
  • Speech Therapy: Speech therapy may be needed to address feeding issues in the infant and speech issues in the child.
  • Prosthetics: Sometimes oral appliances are helpful to improve feeding and/or speech.

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Feeding and Nutrition of Children with Cleft Lip and/or Palate

Babies and children with cleft lip and/or palate are at risk for feeding difficulties. As a result, they may not receive enough macro and macronutrients. They can quickly become malnourished.

Potential Problems or Feeding Difficulties in Cleft Lip and/or Palate

  • Because of the opening between the mouth and nose, an infant with a cleft may have difficulty creating the necessary suction to pull milk from the bottle or breast.
  • The baby may take a long time to feed.
  • Milk may come out of the baby’s nose during feeding. This is called “nasal regurgitation.”
  • The baby may swallow excess air while bottle feeding.

Potential Solutions

  • Feed the baby in a more upright position to prevent milk from coming out of the nose. Upright feeding also helps prevent ear infections.
  • Try using specialized bottles, such as the Haberman Feeder or Pigeon nipple.
  • Adapt standard or preemie bottles by making crosscut slits in the nipples to increase flow:
    • Turn the nipple inside out.
    • Take a sharp, thin blade or scissors to cut a small “X” in the tip of the nipple. Turn the nipple outside in. Sterilize the nipple.
    • After every few sucks, the size of the X can be increased until the infant is eating comfortably.
    • You can test the flow by turning the bottle upside down. If it flows rapidly, but you can still see individual drops, it’s usually right.
  • Use bottle liners so you can squeeze the liner and control the flow.
  • Burp the infant frequently if she is swallowing too much air.

Spoon-Feeding a Child with Cleft Palate

Most likely, the child will be ready for spoon feeding before his cleft palate is repaired. Most children have little trouble adapting to spoon feeding. They may push the food out with their tongues, cough, or get a little food up their nose. Usually this period of adaptation is brief and with repeated tries, they will soon become proficient.

If the cleft is still open, the child may get a little food up his nose. He may sneeze the food out, swallow it down with the next bite, or need a little sip of fluid. If the nasal passages become noticeably clogged, give him a little water. If his nose is still blocked, gently suck the material out of each side with a bulb syringe and then rinse with a little water.

Surprisingly few children with cleft lip and palate have any long-term problems eating purees or table foods. If the child consistently rejects the idea of spoon feeding or cup drinking, he is probably not developmentally ready to take that step. Discontinue and try again in a few weeks.

After the palate is surgically repaired, any problems with mealtimes should decrease. Sometimes, a small hole called a fistula may remain or develop in the roof the mouth at the site of the original cleft. At times, food or liquid may come through or get lodged in the fistula. Most children become very adept at clearing any liquid or food particles on their own. If leaking or reflux through a fistula is fairly frequent or bothersome, be sure and discuss the situation with the child’s doctor to come up with a solution to the problem.

Learn about A Child’s Best Start cleft bottle project in China.

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