Cleft palate and cleft lip are birth defects that occur when the upper lip and palate do not develop properly in the first few months of pregnancy. A baby may have a cleft palate (“cleft” means ‘separate’) or a cleft lip, or both.
During fetal development, it can happen that the tissue that makes up the palate and upper lip does not come together before birth, causing an opening in the upper lip. The opening that is produced can be of variable size, small or large if it goes from the lip to the nose. It can happen on both sides of the lip and, less frequently, it is in the middle.
The term “cleft” refers to the hare that has a natural cleft in the center of the lip, and although it is a popularized adjective, it is not as widely used by professionals, as it is an inaccurate term. The correct description of this condition is “cleft lip .”
Some babies with a cleft lip may have a cleft palate (front or back) if the tissue that makes up the palate does not join properly. Children with cleft lip and palate often have trouble feeding and language development. They are also more prone to ear infections, hearing loss, and dental problems.
Lip malformation occurs between weeks 4 and 7 of pregnancy . It is at this stage that the tissues of your body and special cells on each side of the head grow towards the center of the face and coalesce to form facial features such as the lips and mouth. A cleft lip occurs when the tissue that makes up the lips does not come together completely before birth.
For its part, malformation of the palate occurs between weeks 6 and 9 of pregnancy, when the tissue that forms the palate does not join completely during pregnancy.
These problems can be diagnosed during pregnancy with a routine ultrasound , although a cleft palate is more difficult to see and is sometimes diagnosed after the baby is born. Only some types of cleft palate (such as submucous cleft palate and bifid uvula) may not be diagnosed until later in life.
Cleft lip risk factors
According to the Spanish Society of Aesthetic and Reconstructive Plastic Surgery (SECPRE), these anomalies affect approximately one in every 700 births. According to the Cleft Palate Foundation, each year in the United States, one in 600 babies is born with a cleft palate and / or lip.
The exact cause of orofacial clefts is not completely known . Cleft lip, cleft palate, or both are caused by multiple genes inherited from both parents, as well as environmental factors not yet determined. It is believed that items that the mother comes into contact with, or what she eats or drinks, or certain medications used during pregnancy, may be important.
When a combination of genes and environmental factors causes a condition, inheritance is called “multifactorial” (many factors contribute to the cause).
According to the Centers for Disease Control and Prevention, there are research studies that point to some factors that increase the chances of having a baby with an orofacial cleft, risks that we have discussed on our pages:
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Smoking: Women who smoke during pregnancy are more likely to have a baby with orofacial clefts than women who do not smoke.
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Diabetes: Women with diabetes diagnosed before pregnancy have a higher risk of having a child with a cleft lip, with or without a cleft palate, compared to those without diabetes.
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Use of certain medications : Women who used certain medications for the treatment of epilepsy, such as topiramate or valproic acid, during the first trimester of pregnancy (the first three months) are at increased risk of having a baby with a cleft lip, with or without cleft palate, compared to women who did not take these medications.
Cleft lip management and treatment
Most often, a surgical operation can close the lip and palate and the child can lead a normal life. Surgery for cleft lip is usually performed before 12 months of age, while for cleft palate it is performed before 18 months. Surgical repair can improve the appearance of your child’s face and can also improve breathing, hearing, and speech and language development.
If the child accumulates other complications like the ones we just noted, they may need other surgeries, dental care, and orthodontics. For language development they may need speech therapy. Ultimately, depending on the severity of the cleft, the age, the needs of the child and the presence of associated syndromes or other birth defects, orofacial clefts will receive specific management.
In the United States, the Cleft Palate and Craniofacial Association recommends services and treatments provided by teams that specialize in clefts and craniofacial conditions, as a coordinated approach to the care of children with orofacial clefts is ideal .
There are also specialized teams and centers for clefts and craniofacial conditions in other countries, although it is in developing places where adequate care continues to be lacking. In Spain, the SECPRE also insists that there will be many people from different fields involved in the control of a child’s cleft lip or palate anomaly, since knowledge of many different areas is needed.
The ignorance of this point or the fear of not taking risks has caused abortions to triple in some places due to having a baby with a cleft lip.
Regarding possible self-esteem problems when the child grows up , they may be concerned about the visible differences they have with other children, but there parents have to do a job from the beginning so that, like any other child, they grow with confidence and self-esteem. Parent support groups can also be helpful for families of babies with birth defects of the head and face, such as orofacial clefts.
Feeding the child with a cleft lip
Regarding the feeding of the baby with a cleft lip (only), many can breastfeed with little difficulty , depending on the degree of malformation and the patience and help that the mother receives. It is recommended that a lactation consultant help the mother to find the best position to breastfeed the baby. If the baby is gaining weight appropriately, there will be no need to use special bottles (and if there is, they can also be from expressed breast milk).
When the baby has a cleft palate, special bottles are generally needed to feed, since the little one will not be able to exert enough force to suck due to the malformation. In any case, it is recommended that they be made from breast milk to provide all its benefits to the health of the baby.
Therefore, although a cleft baby has normal suck and swallow reflexes, he needs special bottles and nipples to allow milk to flow without the help of adequate suction. Syringes can be used in hospitals after cleft lip and / or palate surgery and can also be used at home. Typically, a soft rubber tube is attached to the end of the syringe, which will be placed in the baby’s mouth.
During feeding, milk can come out of the baby’s nose, which is called “nasal regurgitation” (it should be in an upright position). The baby can also swallow too much air during feeding (you have to help him pass gas frequently). From this brochure published in Spanish by the Cleft Palate Association of the United States we can see more advice on posture and special bottles.
Prevent cleft lip
As we have seen, some risk factors for cleft lip and palate are known, so since our pregnancy we can help prevent the disorder from occurring by taking vitamin A and folic acid (even before getting pregnant, when planning to have a baby), not trying alcohol and eating a balanced diet.
Smoking is not recommended either (for this and many other reasons) and of course you should not self-medicate in any case. It is advisable to make a preconception visit to the gynecologist (that consultation that is made to the doctor before getting pregnant, when we plan to have a child) and especially if you suffer from a chronic disease.
Photos | iStock
More information | CDC, SECPRE
In Babies and more | They identify the first genetic variant associated with cleft lip, Drinking alcohol during pregnancy increases the risk of cleft lip, Controversy in the United Kingdom after tripling abortions due to the baby having a cleft lip
