Cleft Lips and Cleft Palate in Babies

Children are sometimes born with a split in the upper lip. This is called cleft lip; cleft meaning split. While some children have only a small notch on their lips, others may have prominent splits. In some babies, the cleft can be on both sides of the lips. Let us figure out what causes cleft lips in babies and how it can be treated.

There is no definite cause for cleft lip or cleft palate in children. Researchers say that both genetic and environmental conditions may be responsible for it. So, either a child may inherit his cleft lip or palate from someone in the family or it may be caused due to the intake of certain medications during pregnancy.

Also, women who drink, smoke, or take drugs during pregnancy are at higher risk of giving birth to infants with birth defects like clefts.

Children develop a cleft lip or palate in the mother’s womb. It is also believed the cleft lips or palates occur when some parts of head, face, and skull don’t join properly during the development phase in the mother’s womb.

Cleft lips or palates are diagnosed soon after birth. In some cases, it is also seen in the 2^nd level scan which is done in the 18^th or 20^th week of pregnancy.

Sometimes a cleft palate is not visible at all in newborns. It is hidden by the roof of the mouth. It is called sub-mucous cleft palate. This is detected only when the baby is 3 to 5 years of age. Children with this condition may have nasal sound while speaking. They may also not be able to blow a candle or drink out of a straw.

A cleft lip or cleft palate can only be fixed with a surgery. If your baby has a cleft lip, he should have a surgery when he is 2 to 3 months old and if your baby has a cleft palate then his surgery will be scheduled when he is 6 to 9 months old. If your baby has both, then the first surgery will take place when he is 3 months old and the 2^nd surgery will take place when he is 9 months old. A special cleft team within the specialist centre will work on your baby to treat this problem. The team usually consists of cleft surgeons, cleft specialist doctors and nurses, speech therapists, clinical psychologists, children’s dentists, hearing specialists, and pediatric ENT surgeons.

If the cleft affects your baby’s gums, then he may have to go through a minor graft operation when he is 9 to 11 years old.

What Do Cleft Lip and Palates Look Like?

A cleft lip baby has a split on the upper lip. In some children, it is as small as a notch, while in others it may look like a prominent cut.

Cleft palate, on the other hand, is a split in the roof of the mouth. Cleft palate is usually a small gap in the roof of the mouth. But if the condition is severe, then the roof of the mouth may be completely separated.

Cleft palate can occur independently without a cleft lip.

Who Can Suffer From Cleft Lip and Cleft Palate?

This condition affects around 700 babies annually. It is 4^th most common birth defect detected in children in the US. Clefts are usually seen in children from Asian, Latino or Native American descent. Cleft lips appear more in boys without a cleft palate whereas cleft palate is seen more in girls without cleft lip.

How Do Cleft Lips and Cleft Palates Form?

Cleft lip and cleft palates are formed in the first 6 to 8 weeks of pregnancy. During this phase, the bones and tissues of baby’s upper jaw and mouth come together to form the upper lip and the roof of the baby’s mouth. If these parts don’t fuse together normally, then a cleft lip or palate forms.

Both cleft lips and cleft palates vary in size. While for some it may be almost invisible, in others it may appear more prominently and may cause issues.

What are the Causes?

The definite causes of cleft lips and cleft palates are unknown. It is believed that a cleft lip or palate could be caused due to changes in the genes or combination of genes. The other factors that may be responsible for causing cleft lip and cleft palate in newborns include:

• Smoking during pregnancy
• Women diagnosed with diabetes before pregnancy
• Use of certain medicines during pregnancy, especially the medicines used to treat epilepsy

Problems Faced By Children Having a Cleft Lip or Palate

The symptoms associated with cleft lip and cleft palate are as follows:

• A child who has a split in the palate or in the lip will have eating issues. The food and liquid will pass from the mouth back towards the nose. There are specially made baby bottles and nipples available in the market that will help your baby to eat. Children with split palate may have to wear a manmade palate to help him/her eat better.
• You may observe that children with cleft palate may have hearing issues.
• A nasal tone while speaking is also one of the symptoms of cleft palate.
• Children suffering from cleft palate may also have dental issues like cavities or malformed or displaced teeth.

Diagnosis and Tests

As discussed before, cleft lip or palate can either be diagnosed with the 2^nd level of ultrasound that is usually done in the 18^th or 20^th week of pregnancy or it is diagnosed once the baby is born. So, they are either seen in the scan, which is rare or picked immediately after birth.

Risk Factors That May Increase the Chances of a Baby Developing a Cleft Lip or Cleft Palate

The two main risk factors that increase the chances of a baby developing a cleft lip or cleft palate are:

• Mothers who are in the habit of smoking, drinking, and taking drugs during pregnancy usually give birth to children with clefts. These habits usually affect the baby in the womb during the first and second week of pregnancy.
• Also, children born to mothers, who were taking seizure/anticonvulsant drugs, acne drugs containing Accutane and methotrexate, or drugs used for treating cancer, arthritis, and psoriasis, during pregnancy, are on the higher risks of developing clefts.

Complications With Cleft Lip and Cleft Palate

Children with cleft lip and cleft palate can have few complications that can be taken care of through the right treatment. Problems with cleft lip and palate vary from children to children. The most common ones are:

• Cleft palate can cause severe hearing problems. If the problem is not treated on time, then ear infections caused due to cleft palate can cause hearing loss.
• Children with cleft lips or palates also have serious speech issues. Their speech is difficult to comprehend and in some cases, their speech is nasal.
• Children with clefts have far more cavities than other children. Some children also have missing, extra, malformed or displaced teeth. Children with cleft palates have a more severe dental complication. They may have alveolar ridge defect. Children suffering from alveolar ridge defect may have replaced, tipped or rotated permanent teeth. It can also prevent permanent teeth from appearing or prevent alveolus, the bony upper gum from forming.

Who Can Treat Clefts?

There is a specialized and dedicated medical team that specialises in treating clefts-

• A cleft surgeon who performs necessary surgeries on lips and palates.
• Specialised cleft doctors and nurses who help in evaluating the problem.
• An ENT doctor to evaluate and treat hearing problems.
• An oral surgeon who operates on the upper jaw and repairs the cleft of the gum.
• An orthodontist who repositions the teeth.
• A prosthodontist who makes artificial teeth and other necessary teeth accessories to ensure its sound function and also to set them right.
• A speech therapist to work on speech and eating issues
• A hearing specialist or audiologist to monitor hearing.
• A clinical psychologist to help the child and family cope with its complications through counselling.

Treatment Of Cleft Lips/Palates

Management of cleft lip or a cleft palate can only be done through surgeries. A cleft lip can be treated with two surgeries. The first surgery is usually done under very light anaesthesia when the baby is 3 months old. The second surgery is done when the baby is about 9 to 12 months old.

The treatment of cleft palate can be extended to 18 years of age involving multiple surgeries and cleft palate ultrasound from time to time to determine the next course of action. To create a functional palate, the first surgery usually takes place when the baby is 6 to 12 months old. This surgery also protects the middle ear from getting infected and helps in the proper development of teeth and bone. The second surgery of cleft palate takes place around the age of 8. This is to fill in the upper gum line so that it can support the permanent teeth structure. Once the permanent teeth are formed, braces are put to straighten them.

Other surgeries may be performed on children with cleft palates to fix the appearance of lips and nose, close openings between mouth and nose, and to realign jaws. A final surgery may be required during adolescence to remove the scar from the initial surgeries.

Dental Care For Child With a Cleft Lip or Cleft Palate

As mentioned earlier, children with cleft lips and cleft palates have dental issues that require greater care and may require close monitoring. But the main dental care practices remain the same as other kids.

Early dental care practices include proper cleaning, good nutrition, and fluoride treatment for healthy teeth. Children with cleft lips and palates are usually advised to use toothette, a mouthwash with a sponge on the handle which is used to swab the teeth. This is because a normal soft brush may not work with children with clefts due to the irregular shapes of their teeth.

Children with clefts have to go through orthodontic treatment for proper development of the jaw and aligning of the permanent teeth.

A prosthodontic consultation is also important for children with clefts. This is needed to assess the child’s need and make either a dental bridge, speech bulbs or palate lifts based on the child’s problem. The prosthodontist will work closely with an oral and plastic surgeon and speech pathologist to fix the problem.

How Should You Breast Feed Your Baby With Cleft Lip or Palate?

While children with cleft lips can be breastfed even before the surgery, children with cleft palates may have issues with breastfeeding and may need bottles and nipples designed for children with clefts, which are easily available in the market these days. In this case, you have to express your breast milk and put it in the bottle to feed your baby.

In order to breastfeed children with clefts, mothers have to try various breastfeeding positions, While, these positions will work with children with cleft lips, the same may not work with children with cleft palate. Doctors may suggest at a late stage that your baby wear a manmade palate to eat better.

Is There Any Possibility Of Prevention?

Maintaining a healthy lifestyle and food habits during pregnancy may help prevent clefts in children. Avoid medications of any kind and strictly avoid alcohol, smoking and use of drugs during pregnancy. These are the only possible preventive measures that you can take during pregnancy.

How To Help Your Child?

Children with clefts sometimes face teasing issues due to their appearance or speech issues. Encourage your child to be confident. Ensure that everyone at home is warm, supportive and accepting. Get your child involved in sports, music and other curricular activities. You may even speak to his/her teacher and set up a session for his/her classmates to brief them on clefts and the challenges that come along with it. Take the help of a medical practitioner in doing so.

With multiple surgeries and regular consultations with doctors, children with clefts miss school frequently and may find it difficult to cope with academic and peer pressure. But just remember that children with clefts can grow up to be healthy and happy adults. All they need is your love, support, and acceptance.