What You Should Know About Cleft Lip and Cleft Palate

If your child was born with a split in their lip or the roof of their mouth, they have an orofacial cleft. These conditions are common. About 0.1% to 0.2% of children born in the U.S. each year have a cleft lip or palate. Orofacial clefts can be treated with surgery, but your baby will often need extra feeding support.

Below, we will discuss the types and causes of orofacial clefts, how they’re treated, and what to expect if your baby needs treatment.

What are the different types of orofacial clefts?

There are two major types of orofacial clefts: cleft lip and cleft palate. These two clefts can happen together – called cleft lip and palate – or alone.

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Cleft lip

During the fourth to seventh weeks of pregnancy, the baby’s lip tissues join together. A cleft or separation happens when the tissues don’t join together completely. In the past, a cleft lip was sometimes called “a harelip” but this offensive term is not used by medical teams.

While cleft lips usually form on one side of the upper lip, they can happen on both sides. But not all cleft lips look the same. Some cleft lips can be very shallow and small, while others are larger and extend all the way up into the nose. Many cleft lips exist somewhere in between these two appearances.

Cleft palate

The roof of the mouth– or the palate – forms between the sixth and ninth weeks of pregnancy and contains two parts: the hard palate and the soft palate.

Similar to cleft lip, a cleft palate happens when the mouth tissues don’t join together fully.

Cleft palates also have many different appearances. A cleft palate can run along the roof of the mouth and cross both the hard and soft palates. Sometimes the lining of the mouth hides the cleft palate. Again, many people with cleft palates have a cleft that is somewhere between these two ends of the spectrum.

What causes orofacial clefts, and can you prevent them?

It’s not clear why children are born with orofacial clefts. But it’s likely that both the environment and genetics play a role in cleft development.

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Research suggests that a baby is more likely to develop an orofacial cleft if they are exposed to certain factors during pregnancy like:

• Cigarette smoke: In one study, researchers found that babies exposed to smoke during pregnancy were two times more likely to have an orofacial cleft.

• Diabetes: People who have a history of diabetes are more likely to have a child with an orofacial cleft.

• Medications: Pregnant people who took medications to prevent seizures, like phenytoin, topiramate, and valproic acid, were more likely to have a child with an orofacial cleft.

• Alcohol: In another study, infants exposed to alcohol during early pregnancy were more likely to be born with an orofacial cleft.

Orofacial clefts can also run in families. During your pregnancy, there are a few things you can do to help lower the risk of your baby developing an orofacial cleft like:

• Quitting smoking

• Abstaining from alcohol

• Taking a folic acid supplement

• Making sure your medications are safe to use

How are orofacial clefts treated?

At first, it can be alarming to find out that your baby has a cleft lip or palate. But orofacial clefts can be treated with the help of your healthcare providers. For example, most children's hospitals have entire centers with all the resources you need for your child, including:

• Otolaryngologists (an ear, nose, and throat specialists)

• Plastic surgeons

• Speech and language pathologists (including feeding specialists)

• Nutritionists

• Lactation consultants

• Occupational therapists

• Pediatric dentists

• Audiologists

Ultimately, your baby will need surgery to repair the cleft.

Since orofacial clefts can make it difficult for babies to eat, your lactation consultant and speech pathologist can help you design a feeding plan for your baby until it’s time for surgery. Special tools are available to help your baby feed – including nipples and bottles made specifically for babies with clefts. Depending on the size and location of the cleft, your child may even be able to breastfeed.

Before and after surgical repair, you’ll work with your surgeon and dentist to come up with a strategy. Surgeons can repair a cleft lip relatively early, usually when your baby is between 2 and 6 months old. However, they wait a little longer to repair cleft palates. Infants with cleft palates will often have their cleft fixed when they are 9 to 18 months old. Depending on your child’s cleft, they may need more than one procedure for the best possible outcome.

Once the repair is complete, your team will continue to work with your family and help with your child’s:

• Speech development: The lips and palate help your child form words and make sounds. A speech pathologist will watch your child’s speech progress to make sure it develops normally and provide therapy if needed.

• Hearing: If your child’s cleft involves the soft palate, the structure draining the middle ear – the eustachian tube – may be affected. This can make your child more prone to inner ear infections. Frequent ear infections can damage your child’s hearing. Your otolaryngologist and audiologist can confirm your child isn’t having too many infections. They may also recommend ear tubes to prevent frequent infections and protect your child’s hearing.

• Teeth eruption: Sometimes a cleft palate may involve the gums and affect tooth development. Your pediatric dentist will follow your child carefully to make sure their teeth are erupting the right way and recommend orthodontics if there are any concerns.

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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