Cleft Palate

Topic Overview

What is cleft palate?

Cleft palate is a treatable birth defect. It happens when the roof of the baby's mouth (palate) does not develop normally during pregnancy, leaving an opening (cleft) in the palate that may go through to the nasal cavity. A cleft can form on any part of the palate, including the front part of the roof of the mouth (hard palate) or the small flap of tissue that hangs down from the soft palate (uvula). It may appear by itself or along with other birth defects of the face and skull, such as a cleft lip.

Cleft palate and cleft lip are the most common birth defects of the head and neck. Until it is treated with surgery, a cleft palate can cause problems with feeding, speech, and hearing.

See pictures of two different types of cleft palate and two types of cleft lip.

What causes cleft palate?

Doctors aren't sure what causes it. But your baby may be more likely to have cleft palate if you:

Use certain medicines while you're pregnant.
Use alcohol or illegal drugs while you're pregnant.
Smoke while you're pregnant.
Are exposed to radiation or infections while you're pregnant.
Have a family history of cleft palate.

It's important to take good care of yourself before and during your pregnancy so that your baby will be as healthy as possible.

What are the symptoms?

Some forms of cleft palate are easy to see when the child is born. But even if the defect does not affect how the baby’s face looks, it can usually be seen inside the mouth.

The location of the cleft matters more than how it looks. A small cleft in the soft palate may cause more problems—because of its effect on speech—than a large cleft that is easy to see.

Babies with cleft palate often have feeding problems because they are not able to suck and swallow normally. But this does not always last, especially with treatment.

How is cleft palate diagnosed?

A doctor can diagnose cleft palate by doing a physical exam of the baby’s mouth shortly after birth.

Fetal ultrasound can sometimes find cleft palate as early as 14 to 16 weeks into pregnancy, especially if the cleft palate is severe and occurs along with a cleft lip. But ultrasound doesn't always find the problem, so doctors don't rely on it to diagnose cleft palate.

How is it treated?

Treatment involves a team of health care providers. The type of treatment depends on how severe the problem is.

Surgery is the most common treatment for cleft palate. For the most part, it’s done when the child is between 12 months and 18 months old. As your child grows, he or she will probably need more than one operation. But the problem is normally fixed by the time a child is a teen.

Although surgery often leaves scars, the palate usually heals well and leaves few signs of the cleft. A child’s facial bones most often grow normally, and the child speaks more clearly.

Some children with cleft palate need more treatment for other problems, such as speech, hearing, or teeth problems; sinus and ear infections; and problems from surgery.

What can you do at home to help you and your child?

If your baby is born with a cleft palate, get help with feeding. A nurse can guide you on feeding techniques. Watch for infections and hearing or teeth problems too.

As your child with cleft palate grows, pay special attention to dental care, hearing, and speech.

Caring for a child with cleft palate can take a lot of time and patience. Seek support from friends and family. You can join a support group to meet others who are going through similar challenges.

Frequently Asked Questions

Learning about cleft palate:	What is cleft palate? What are the symptoms? How common is it? Can it be prevented? How are cleft lip and cleft palate related?
Being diagnosed:	How is cleft palate diagnosed? What kind of physical exam is given? What are the different classifications of it? What are some common concerns parents have?
Getting treatment:	How is it treated?
Ongoing concerns:	How do I feed my baby? How can I help my child?

Symptoms

The symptoms of cleft palate vary depending on the location of the cleft and whether other facial defects are present. Babies born with cleft palate often have feeding difficulties, because the condition interferes with normal sucking and swallowing. Sometimes you can't see a cleft palate when you look at a baby's face. But you can usually see it inside his or her mouth. If your baby also has cleft lip, the clefts may be easy to see on your newborn's face.

The following table illustrates the common symptoms related to cleft location.

**Common symptoms related to cleft location**
Location of cleft	Common symptom
Hard and soft palate	Facial defect
Soft palate	Liquids leak from nose
Hard palate	Weak suck, difficulty swallowing, gagging, choking

See a picture comparing a normal mouth and two types of cleft palate.

Children with cleft palate may have large tonsils and adenoids. Most doctors agree that these structures should not be removed. They may help children with cleft palate to speak more clearly by allowing higher pressure to build up in their mouths during speech.

Certain health and social problems, especially speech, hearing, and dental problems, are more common in children born with cleft palate.

Cleft palate is sometimes a symptom of another health condition, such as fetal alcohol syndrome. For this reason, it is important for children with cleft palate to be evaluated for other conditions beginning at birth, especially if other symptoms are present, such as other facial deformities.

Exams and Tests

A diagnosis of cleft palate is based on a physical exam of the baby's mouth at birth. If your newborn is diagnosed with cleft palate, he or she will likely also be examined for other birth defects, such as a small jaw.

See a picture comparing a normal mouth and two types of cleft palate.

Although rare, cleft palate is sometimes a symptom of another health condition, such as fetal alcohol syndrome. For this reason, it is important for children to be evaluated for other conditions beginning at birth, especially if other symptoms are present, such as other facial deformities or learning disabilities.

Some children with cleft palate may need testing for complications, such as speech and hearing problems, throughout their lives.

Early detection

Fetal ultrasound can sometimes detect cleft palate as early as 14 to 16 weeks of gestation, especially if it is severe and occurs along with a cleft lip. But fetal ultrasound is not reliable for this purpose. For more information on this test, see the topic Fetal Ultrasound.

Cleft lip or cleft palate can be passed down through families (inherited). If you have a family history of cleft lip or cleft palate, you may benefit from genetic counseling. A genetic counselor can help you understand your chances of having a child with a cleft lip or cleft palate.

Sometimes an inherited disease or condition causes a number of defects including cleft palate. If you have had a fetal ultrasound that shows your fetus is likely to have cleft palate and other defects, you may decide to have genetic counseling along with amniocentesis or karyotype testing. These tests and genetic counseling can help you learn whether your fetus is likely to have a condition caused by chromosomes that aren't normal. Karyotype testing can also be done after your baby is born.

Treatment Overview

Surgery is the primary treatment for cleft palate. Sometimes multiple procedures are needed over several years to fully correct the defect. Additional treatments depend on the severity of cleft palate and whether other problems develop, such as speech or feeding problems. Some treatments, such as speech therapy, may continue into early adulthood.

Before surgery

Before surgery to correct a cleft palate, your baby may need treatment:

For breathing difficulties. Some babies born with cleft palate have obstructed airways. Treatment depends on the severity of the problem. For example, some babies can be given oxygen through a tube in the nostrils. In rare cases, emergency measures are needed, such as a tracheotomy.
For feeding difficulties. Babies with cleft palate usually have difficulty sucking and swallowing. A doctor or nurse can guide you on feeding techniques. Also, your baby will be closely monitored for signs of dehydration.
To prepare the mouth for the surgery. Dental supports may be used immediately after birth or within the first 2 to 3 weeks of birth. These supports are made from plastic or metal molds (sometimes called a baby plate or obturator) to help reshape the tissues.

Surgical repair of cleft palate

Generally, surgery is performed between ages 12 months and 18 months to promote normal speech and language development.¹ Before age 6 months, surgical repair of cleft palate may cause problems with normal facial growth. In some situations, doctors may prefer to wait until the baby is 18 months of age, to avoid damaging the teeth buds or for other reasons related to your child's circumstances. Surgery to correct a cleft of the soft palate may be done earlier than surgery to correct a cleft of the hard palate. See a picture comparing a normal mouth and two types of cleft palate.

Additional surgeries may be needed as your baby grows and develops. The number and type of surgeries depend on how much of the palate is affected and other aspects of your baby's health, such as whether another facial defect or health condition is present. For example:

A baby with a cleft of the soft palate may need only one surgery, which usually is done between the ages of 1 and 2. It sometimes is postponed until the child is between ages 5 and 7 years.
A baby with a cleft that involves both the hard and soft palates may need several surgeries, beginning at birth and continuing until he or she is between 10 and 13 years of age.
A baby who has cleft palate and other facial birth defects, including cleft lip, may need several surgeries, may have more complications, and may need additional treatment.

After surgery

After surgery to correct cleft palate, the doctor will likely give your child antibiotics.

Your baby's arm movements may be restricted with splints or other material for as long as 3 weeks. This measure is sometimes needed to prevent your baby from touching and damaging the stitches.

Babies with cleft palate have problems sucking and swallowing, so feeding can be challenging. Watch for signs of dehydration, which can develop if your baby is not getting enough breast milk or formula. Bottle-feeding is usually more successful than breast-feeding. Some mothers bottle-feed pumped breast milk. After surgery to repair a cleft palate, sucking often feels different to babies, and they must relearn proper techniques. During the adjustment period, your health professional can recommend strategies to help you make sure your baby gets enough nourishment.

Although surgery often leaves slight scars, usually the palate heals well after surgery, with very little evidence of the cleft. A child's facial bones typically grow normally, and the child speaks more clearly.

Other surgeries may be needed to correct the scars. Counseling and additional treatment for speech, teeth, and hearing loss may also be needed. Some children need to have ear tubes inserted surgically to help prevent ear infections.

Speech therapy may be needed as your baby grows and begins to talk. Speech therapy may continue through childhood. If additional surgeries are performed when your child is older, speech therapy may be reintroduced or adapted to meet new challenges.

Home Treatment

Your child's doctor or a health care team will tell you how to care for your newborn if he or she was born with cleft palate. In general, you need to pay special attention to:

Feeding. Babies with cleft palate have problems sucking and swallowing, so feeding can be challenging. Watch for signs of dehydration, which can develop if your baby is not getting enough breast milk or formula. Bottle-feeding is usually more successful than breast-feeding. Some mothers use pumped breast milk to bottle-feed their babies. After surgery to repair a cleft palate, sucking often feels different to babies, and they must relearn proper techniques. During the adjustment period, your health professional can recommend strategies to help you make sure your baby gets enough nourishment.
Infection. After surgery, antibiotics are usually given to reduce the risk for infection. Look for signs of infection, such as a fever or decreased energy level. Make sure your baby drinks adequate fluids, which helps prevent infection and promote healing.

Caring for a child with a birth defect takes a lot of time, patience, and energy. It's easy to ignore your own needs as you care for your child. Consider these suggestions for parents of children with cleft palate or cleft lip.

As your child grows, pay attention to:

Dental care. Children with cleft palate need to establish good dental habits early in life. Talk with your child about the possible need for braces. This may relieve some of your child's fears about permanent problems with uneven teeth. If possible, have a pediatric (children's) dentist take responsibility for the overall dental care of the child with cleft palate.
Hearing. Babies with cleft palate need to have their hearing tested by the time they are 3 months old. In some cases, babies born with cleft palate need ear tubes surgically inserted to help the middle ear function properly and to restore hearing, reduce pain, and prevent chronic middle ear infections and future hearing problems. Ear tubes are made of hollow plastic and require special care.

Preventing cleft palate

Experts are still trying to find answers about why some babies are born with cleft palate. Although sometimes cleft palate is passed down through families (inherited), in most cases the cause is not known. Research continues on how genes and a mother's health—what she eats and drinks and hazards she is exposed to during pregnancy—can result in the fetus developing cleft palate. For example, a mother who smokes or drinks alcohol during pregnancy may increase the risk that her baby will be born with cleft palate.

Take good care of yourself before and during pregnancy so that your baby will be as healthy as possible. You can do some things to help prevent your fetus from developing cleft lip or cleft palate, such as taking prenatal vitamins. Also, do not smoke or drink alcohol while you are pregnant.

What to think about

If your child is born with cleft palate, it is normal to have concerns and feelings including anger, fear, guilt, depression, or denial. You may find it helpful to talk with your child's doctor or see a counselor. Also, you may find a support group helpful. Support groups help you to interact with other parents who have babies with cleft palate.

Fortunately, cleft palate is correctable with surgery, and scarring is usually minimal. The most difficult period will likely be the first weeks or months before and during surgery. You may wonder how your friends, relatives, other children, and even strangers will react to your baby's appearance. Try to focus on developing a bond with your baby. The rest will fall into place over time.

Talk to your other children about your baby's cleft palate. Emphasize that no one is responsible, that it does not hurt, and that it can be corrected with surgery.

As your child grows, consider explaining how clefts develop. Help your child understand that being born with a cleft palate has been a part of making him or her strong and special. Teach your child how to answer questions from peers and adults about his or her appearance. You can help minimize concerns or self-consciousness by helping your child understand and accept the condition as one of many life experiences.

Other Places To Get Help

Organizations

AboutFace
123 Edward Street
Suite 1003
Toronto, ON Canada MSG 1E2
Phone:	1-800-665-FACE (1-800-665-3223) (416) 597-8494
E-mail:	info@aboutfaceinternational.org
Web Address:	www.aboutfaceusa.org

AboutFace is a nonprofit international organization that provides information, support, and other resources to people who have facial differences. They have information on cleft palate, cleft lip, and other conditions.

American Society of Plastic Surgeons
444 East Algonquin Road
Arlington Heights, IL 60005
Phone:	(847) 228-9900
Web Address:	www.plasticsurgery.org

The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world. This site has news on the latest advances and techniques of specific surgical procedures. It includes information on how to prepare for surgery, types of anesthesia used, recovery time, and average costs. You can find a qualified surgeon in your area, view before-and-after photographs, and read patient stories.

Cleft Palate Foundation
1504 East Franklin Street
Suite 102
Chapel Hill, NC 27514-2820
Phone:	1-800-24-CLEFT (1-800-242-5338) (919) 933-9044
E-mail:	info@cleftline.org
Web Address:	www.cleftline.org

The Cleft Palate Foundation is a nonprofit organization that has information for children, adults, and families affected by clefts and other craniofacial birth defects. It was founded by the American Cleft Palate-Craniofacial Association, an international nonprofit group of health professionals who are involved in treatment and/or research of craniofacial conditions. The Web site has information about treatment, feeding, dental care, speech, hearing, and more. You can call the toll-free phone number to get medical information and to find support groups.

KidsHealth for Parents, Children, and Teens
10140 Centurion Parkway North
Jacksonville, FL 32256
Phone:	(904) 697-4100
Fax:	(904) 697-4125
Web Address:	www.kidshealth.org

This Web site is sponsored by the Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This Web site offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly e-mails about your area of interest.

March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone:	(914) 997-4488
Web Address:	www.marchofdimes.com

The March of Dimes tries to improve the health of babies by preventing birth defects, premature birth, and early death. March of Dimes supports research, community services, education, and advocacy to save babies' lives. The organization's Web site has information on premature birth, birth defects, birth defects testing, pregnancy, and prenatal care. You can sign up to get a free newsletter and also explore Understanding Your Newborn: An Interactive Program for New Parents.

Related Information

References

Citations

Cunningham M (2003). Cleft lip and cleft palate section of Birth defects, malformations, syndromes. In CD Rudolph, AM Rudolph, eds., Rudolph's Pediatrics, 21st ed., pp. 748–753. New York: McGraw-Hill.

Other Works Consulted

Beers MH, et al., eds. (2006). Craniofacial abnormalities. Merck Manual of Diagnosis and Therapy, 18th ed., pp. 2422–2424. Whitehouse Station, NJ: Merck Research Laboratories.

Edwards SP, et al. (2007). Cleft lip and palate. In DM Laskin, AO Abubaker, eds., Oral and Maxillofacial Surgery, pp. 135–151. Chicago: Quintessence Publishing.

Glenny AM, et al. (2004). Feeding interventions for growth and development in infants with cleft lip, cleft palate, or cleft lip and palate. Cochrane Database of Systematic Reviews (3).

Hoffman WY (2008). Cleft lip and palate. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, section 6, pp. 323–339. New York: McGraw-Hill.

Kapp-Simon KA (2006). A brief overview of psychological issues in cleft lip and palate. In S Berkowitz, ed., Cleft Lip and Palate, 2nd ed., pp. 257–261. New York: Springer.

Klein U (2009). Cleft lip and palate section of Oral medicine and dentistry. In WW Hay Jr. et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 429–430. New York: McGraw-Hill.

Mossey PA, et al. (2009). Cleft lip and palate. Lancet, 374(9703): 1773–1785.

Rowe LD (2009). Congenital disorders of the oral cavity and lip section of Congenital anomalies of the head and neck. In JB Snow Jr, PA Wackym, eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 17th ed., pp. 835–838. Hamilton, ON: BC Decker.

Shi M, et al. (2007). Orofacial cleft risk is increased with maternal smoking and specific detoxification-gene variants. American Journal of Human Genetics, 80(1): 76–90.

Wolfe SA, et al. (2006). Surgical treatment of clefts of the lip and palate from birth to age ten. In S Berkowitz, ed., Cleft Lip and Palate: Diagnosis and Management, 2nd ed., chap. 22, pp. 459–475. Berlin: Springer.

Credits

Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	John Pope, MD - Pediatrics
Specialist Medical Reviewer	Donald R. Mintz, MD - Otolaryngology
Last Updated	January 21, 2010

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