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Cleft lip and palate

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

Cleft lip and palate affects one baby in about 700 - it is a condition with which children are born. We do not know what causes cleft lip and palate - in most cases the cause is unknown but it is in your baby's genetic make-up and thus inherited from both parents. Your baby's lips begin to form at about the 6th week of pregnancy. The palate forms during the 7th to 12th week. The normal development is for closure of "gaps" but clefts form because the face and mouth structures do not close when they should.

Breastfeeding your cleft lip and palate baby

Babies with clefts may take longer to feed than babies without clefts. Babies with a cleft lip can breastfeed however babies with a cleft palate may have trouble breastfeeding. If you wish to breastfeed your baby, talk to a lactation consultant, midwife or speech pathologist before you are discharged from the maternity hospital. Some mothers choose to express breast milk and feed it to their baby through a special bottle (known as a squeeze bottle) and special soft teat, both of which are designed for babies with cleft palates. They are available from CleftPALS (see Cleft lip and/or palate - feeding your baby fact sheet).

Your baby's first admission to hospital

If you live in a country area, and your baby has a complete cleft lip and palate, it is possible that your baby will be transferred to a children's hospital when he or she is only a few days old. During this first admission or outpatient clinic visit, you will meet members of the cleft palate team and an orthodontist who might fit an orthodontic plate. In general, most babies will attend a children's hospital as an outpatient.

Unilateral cleft lip and palate	Bilateral cleft lip and palate	Cleft palate

Surgery

Repairing the cleft depends on your baby's general health, and on the cleft itself. Generally the lip is repaired when the baby is three to six months old and the cleft palate repair is performed between 6 and 18 months of age. Every child is different and some repairs may be performed at different times.

Your child may need more operations later on. These include improving the original lip repair, placement of bone to the bony gap in the palate (which aids the teeth coming down), surgery to the upper or lower jaw to improve the bite and to help with chewing), narrowing of the nose and adjusting the tip of the nose. If your child is having speech problems, more surgery to the soft palate may also be needed.

Unilateral cleft lip repair - Miliard repair	Unilateral cleft lip repair - Tennison repair	Bilateral cleft lip repair - Manchester repair

Hearing

Children with a cleft palate are more likely to have middle ear problems. This can affect their hearing, so all children with a cleft palate have regular hearing tests. Sometimes, it may be necessary to put a tube called a grommet into the eardrum to ventilate the middle ear and stop fluid from building up. Grommets are often inserted at the time of the palate repair.

Speech and Teeth

A speech pathologist and an orthodontist will also be involved in your child's care. Speech pathologists make sure that your child's speech is developing normally, and help with any speech problems. The orthodontist (a special kind of dentist) makes sure your child's teeth end up straight after erupting. It is essential your child receives regular dental checks. Medicare will assist with the cost of dental checks and orthodontics for children with a cleft lip or palate. To receive these rebates from Medicare, your child will need to be registered as having a cleft lip or palate. This registration form can be filled in when your child attends the Cleft Palate Clinic.

Support group

CleftPALS is a national voluntary organisation of parents and professionals who are interested in children born with a cleft condition. They visit new parents, give help with feeding and are there if you "just want to have a chat". Tel: (02) 9294 8944.

• We don't know what causes a cleft of the lip and palate.
• You need to take special care of your child's mouth and teeth.
• CleftPALS are available to support you.
• Your child's ears, nose and throat should be checked regularly.
• Try to treat your cleft lip and palate child as normally as possible.
• We recommend a local paediatrician be involved in your child's care.
• If you would like further information about the possibility of a cleft happening again, a geneticist will be available to see you and your extended family.

The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 www.chw.edu.au	Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 www.sch.edu.au	Kaleidoscope, Hunter Children's Health Network Tel: (02) 4921 3670 Fax: (02) 4921 3599 www.kaleidoscope.org.au