A cleft lip is when there is a gap in the skin of your baby’s upper lip. Sometimes the gap is just on the lip (unilateral) or up to the nose (bilateral). A cleft lip usually develops during the 5th week of pregnancy.
A cleft palate is a gap in the roof of your baby’s mouth. Sometimes, the gap can also be in the front part of your baby’s gums. A cleft palate usually develops during the 9th week of pregnancy.
How common are cleft lips and/or cleft palates?
Cleft lips can happen in 1 out every 600 babies. Cleft palates can happen in 1 out of every 2,000 babies. This means cleft lips and/or cleft palates are very common. Some babies have just a cleft lip or just a cleft palate, while others can have both.
What causes a cleft lip and/or cleft palate?
There are a few causes of cleft lip and/or cleft palate:
- Taking certain medications during the first 10 weeks of pregnancy, like phenytoin or corticosteroids
- Drinking alcohol
- Low levels of folic acid (a type of vitamin B) during pregnancy
- Cleft lip and/or cleft palates can also run in families. While you’re pregnant, your doctor might do genetic testing or an amniocentesis for syndromes (signs of disorders) that can happen with cleft lip and/or cleft palate.
How do doctors treat cleft lip and/or cleft palate?
We treat cleft lip and cleft palate a few ways, which are:
- Teaching your baby how to suck and swallow. At birth, your baby might have trouble feeding. Cleft lip and/or cleft palate make it harder for your baby to suck and swallow breast milk or formula. A feeding team at MGHfC can help teach you how to feed your baby with bottles designed for cleft lip and/or cleft palate.Your baby’s feeding team includes a speech therapist and an occupational therapist (a therapist who helps people develop living skills). The bottles include the Mead-Johnson® Cleft Lip/Palate Nurser and the Haberman Feeder®.
- Surgery to close the cleft lip or cleft palate. Plastic surgeons can do surgery to fix your baby’s cleft lip and/or cleft palate. For a cleft lip, your baby might be able to have surgery at 5-6 months old if he/she is otherwise healthy. For a cleft palate, your baby might be able to have surgery at 9-12 months old if he/she is otherwise healthy. Sometimes, it takes more than 1 surgery to fix the cleft lip and/or cleft palate. Your doctor will talk with you about surgery for your baby’s cleft lip and/or cleft palate.
What are some challenges my baby might have?
Babies with cleft lip and/or cleft palate sometimes have the following challenges:
- Trouble feeding
- Overbites or underbites
- Missing teeth or teeth that don't grow in as straight as others
- A nose that looks different on either side. This can be fixed with surgery.
- Ear infections
- Trouble hearing
- Trouble pronouncing certain letters and words once they learn to speak. This is because your baby’s lips or the roof of his/her mouth aren’t fully formed when he/she is first born. A speech and swallowing therapist will help your baby with feeding and learning speech as he/she grows up. Your doctor will talk with you about how to help your baby through these challenges.
What is the long-term outlook for my baby?
Once doctors treat the cleft lip and/or cleft palate, your baby might be able to eat and eventually speak without too many difficulties.
Who will care for my baby's cleft lip and/or cleft palate?
As your baby grows up, our doctors from the Cleft Lip and Craniofacial Clinic and Fetal Care Program at MGHfC can provide care from baby years through adulthood.
Members of your baby's care team can include:
- Your baby's primary care doctor
- Plastic surgeons
- Oral and maxillofacial (mouth and jaw) surgeons
- Speech therapists
- Orthodontists (dentist who help correct crooked teeth, overbites and underbites)
- Geneticists (doctors who specialize in genetics)
- Otolaryngologists (ear, nose and throat doctors)
- You and your family also play an important part in your baby’s care. We will make sure to involve you in every step along the way.