In this article:
Understanding Cleft Lip and Cleft Palate
A cleft lip is a gap or split in the upper lip, which can range from a small notch to a larger opening extending into the nose.A cleft palate is when there’s an opening in the roof of the mouth. This can affect either the hard palate (the bony front part) or the soft palate (the softer back part).
These conditions develop very early in pregnancy. When a baby is growing inside the womb, the different tissues of the face and mouth are supposed to join together. This usually happens between the fourth and ninth weeks of pregnancy. If the tissues don’t fully join together, a cleft lip or cleft palate can form.
In India, cleft lip and palate occur in about 1 in 600 to 800 live births. A cleft palate on its own is less common and happens in about 1 in every 2000 births.
Diagnosing Cleft Lip and Palate
Here’s how doctors diagnose it:Prenatal Ultrasound
One of the first ways a cleft lip or palate can be checked is with a prenatal ultrasound. This is the routine scan done during pregnancy where sound waves are used to create pictures of your baby inside the womb. It helps doctors see how your baby is developing.A cleft lip can sometimes be seen as early as 12 weeks. But in most cases, it’s usually picked up during the detailed anatomy scan that happens between 18 and 22 weeks of pregnancy. That’s the scan where doctors look closely at your baby’s organs, bones, and face.
A 3D ultrasound can give an even clearer view because it shows the baby’s face from different angles. This makes it easier to notice a cleft lip or any other differences in facial structure.
A cleft palate, though, is harder to detect before birth. The palate is the roof of the mouth, and an ultrasound can’t show the inside of the mouth clearly. Because of that, only a small number of isolated cleft palate cases are spotted through ultrasound.
Post-Birth Examination
If a cleft isn’t picked up on the ultrasound, doctors will check your baby’s mouth, nose, and the roof of the mouth right after birth. A visible gap in the lip or an opening in the palate confirms the diagnosis.Genetic Counselling
If a cleft is found before birth, your doctor may suggest that you meet with a genetic counsellor. This is a specialist who talks with families about possible causes and whether the cleft could be linked to a genetic syndrome.Sometimes, the doctor may also recommend a test called amniocentesis. In this test, a small sample of the fluid around the baby (amniotic fluid) is taken and checked for other health conditions.
Treatment Options for Cleft Lip and Palate
Treating a cleft lip or palate usually takes a team of specialists who work together to support your child. The goal is to help them eat well, speak clearly, hear properly, and feel confident about how they look.This is what you can expect:
Surgical Treatments
The primary way to repair a cleft lip or palate is through surgery. All surgeries are done under general anaesthesia, which means your child will be asleep and won’t feel any pain during the procedure.The process typically follows this timeline:
Cleft Lip Repair
This surgery is usually done when your baby is between 3 and 6 months old. During the procedure, the surgeon makes small cuts on each side of the cleft and carefully creates tissue flaps. These flaps are then stitched together, including the muscles of the lip. If needed, the surgeon may also repair the nose at the same time to improve its shape. A second surgery may be required around 6 months if further adjustments are needed.
Cleft Palate Repair
This surgery usually takes place between 9 and 18 months of age, after the lip repair is done. The surgeon closes the gap in the roof of the mouth. They carefully reposition the tissues and muscles to rebuild the hard and soft palate.
Techniques like veloplasty or palatoplasty may be used to improve function.
Ear Tube Surgery
For children with a cleft palate, the surgeon may also place small ear tubes during the palate repair. These tubes help prevent fluid from building up in the middle ear, which can cause hearing loss.
Follow-Up Surgeries
Between ages 2 and the late teens, your child may need extra surgeries to improve speech, the appearance of the lip and nose, or jaw alignment.
Non-Surgical Treatments
Beyond surgery, your child may need other treatments to address challenges caused by the cleft:Feeding Support
Babies with a cleft palate often have trouble sucking because of the gap in the roof of the mouth.
A lactation consultant can guide you on breastfeeding or giving expressed breast milk using a spoon, cup, or syringe. Breast milk can also reduce the risk of ear infections, which are common in these babies.
Speech Therapy
Children with a cleft palate often have speech challenges, such as difficulty pronouncing certain sounds like “p,” “b,” “t”.
A speech therapist usually assesses your child around ages 4 to 5. They may recommend regular speech therapy to help your child speak clearly.
Orthodontic Care
Children with clefts may have missing, misshapen, or poorly positioned teeth. Orthodontic treatment often starts around age 6 or 7 to align teeth and support jaw growth.
Dental Care
Taking care of your child’s teeth from the start is very important. Begin cleaning with a soft toothbrush as soon as the first teeth appear, and ask your dentist about fluoride treatments to protect against cavities.
Caring for a baby with a cleft lip or palate takes a team of specialists and lots of support. Step by step, your child can thrive with the right care and support, and you will have guidance every step of the way!
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FAQs on Caring for a Baby with Cleft Lip or Palate - Diagnosis and Treatment
- Can cleft lip or palate be prevented?
There is no guaranteed way to prevent a cleft lip or palate as the causes are often unknown and involve multiple factors. - How long is the recovery after cleft lip and palate surgery?
Recovery usually begins with a hospital stay of a few days. Complete healing typically takes 2 to 3 weeks, though some recovery may extend up to a month.
