In keeping with the causes of cleft lip and palate the steps a pregnant women should take are:
- Eat foods rich in folic acid/ take folic acid supplements
- Avoid smoking
- Avoid alcohol consumption
- Consider Genetic Counselling
- Only take those medicines prescribed by your doctor.
After a child has had surgery to treat a cleft lip or palate the specialists which need to be consulted include:
- Speech and language pathologists.
- A dentist
- Hearing therapists (audiologists).
- Occupational therapists.
- Social workers.
- Lactation consultant.
The treatment of cleft requires a team of specialists. These include Plastic / maxillofacial surgeon Dentists/ orthodontist and ENT specialists and speech pathologist. It is well advised that if a cleft problem is seen in a child, or if any of the aforementioned complications are seen then one needs to take the child to the nearest hospital where one of the specialists must be consulted.
Children often face psychological problems due to the condition. As a cleft deformity is easily distinguishable the children often face self-image problems. Experts advise explaining the condition to the child as soon as they are old enough to understand. Treat it as a normal topic of conversation.
One can also help strengthen the child's independence by involving them in the decision-making process about their treatment and their life in general.
- Can our baby be fed properly - Babies with cleft can experience problems while feeding specially those who have cleft palate and can’t suckle properly
- will our baby’s teeth grow properly - Cleft lip and palate cause changes to the structure of the mouth and hinder the development of teeth, this makes them more vulnerable to tooth decay
- Will our baby have trouble talking – The roof of the mouth plays an important role in helping a child form sounds for speech.
If a cleft palate is not repaired it will lead to speech problems when the child is older. That is why cleft palate is repaired before speech development starts in most cases the child goes on to develop normal speech but will require speech therapy
- can our child have hearing problems- Children with cleft palate often develop a condition called glue ear, where sticky fluid collects in the middle ear behind the eardrum. This may reduce their level of hearing and can sometimes cause ear infections.
The above complications may need individual attention and treatment aside from surgery.
Cleft is usually treated with surgery.
Lip Repair Surgery- This surgery is usually performed when the child is 3-6 months old. In this surgery the cleft lip is usually repaired including the underlying muscles and the nose is usually repaired at the same time.
Palate repair Surgery- Palate repair surgery is usually performed when the child is 10 to 12 months old. The muscles and lining of the palate are rearranged. In most cases no extra tissue is needed to complete the operation. Speech therapy is recommended for all children, following closure of cleft palate.
The timing of the suregry also depends upon the general nutritional status and health of the child, an average weight of 10 pounds and a hemoglobin of 10 g/dl is required for a safe surgery.
In most cases the exact cause is unknown but it is thought to be a combination of genetic and environmental factors.
Inherited genes- Genes a child inherits from his parents occasionally makes him more vulnerable to developing cleft lip and palate.
- Lack of folic acid during pregnancy- Folic acid helps reduce the chances of birth defects. It is found in food like lentils, dark green vegetables and citrus fruits to name a few
- Smoking- A mother pregnant woman who smokes increases the chances of her baby being born with a cleft. She should also avoid second hand smoking
- Alcohol consumption- Alcohol consumption during pregnancy can lead to development of cleft lip and palate problems
- Obesity- Mothers who are obese have a higher chance of having children with cleft lip and palate
No. Some children with clefts have clefts that involve the lip and palate. Some have clefts that involve only the lip and some have clefts that only affect the palate.
1 in every 800 live births
35,000 children are born with cleft lip and palate every year
approximately 25- 30% children receive any kind of surgery creating a huge back log of clefts in our country
The figures are affected by the issue of abortion once a cleft lip or palate is detected in the ultrasound.
Cleft problems are usually found during ultrasound scans between the 5th & 9th week of pregnancy and if not, then they are detected at the time of birth Some cleft problems are hidden by the lining of the mouth and are detected when speech problems begin which could take months and even years.
The common signs one should look out for are:
- Milk frequently coming out of the baby’s nose while feeding
- The inability to suckle, drink from a straw, blow out candles etc.
- Nasal sounding speech
How should I feed my child?
Feeding the infant takes patience and practice. We recommend soft squeezable plastic bottle with long nipples. You can increase the flow by gently squeezing or putting pressure on the bottle. It is important to feed the infant before he/she becomes too hungry. Position the infant in an upright position with the head tilted back slightly. This position allows the milk to flow down into the throat and less into the nose. Infants with clefts do swallow more air and need to be burped more frequently. Generally the infant cannot produce enough negative pressure to obtain ample breast milk to provide adequate nourishment. Using a breast pump to extract the milk and feeding the infant breast milk from a squeezable bottle is recommended.
A cleft is a gap/split in the upper lip or the roof of the mouth-palate (and sometimes both). It may be one-sided or affect both sides. It occurs when separate areas of the face do not join together properly while a baby develops during pregnancy.
Below are some pre and post-op pictures of cleft lip and palate repair