Cleft lip and palate - Problems related to a cleft lip and palate

Giving birth to a baby with a cleft can have a profound psychological impact both on the parents and the child.

It's common for parents to feel guilty, angry, shocked, helpless or disappointed.

However, it's important to realise that in most cases a cleft cannot be prevented and you are not to blame. Some parents may worry that they will be unable to bond with a child who has a cleft, but there's no evidence this is the case.

Your cleft care team will be used to supporting parents during the difficult time that can follow the birth of a baby with a cleft. Take this opportunity to express any concerns and worries you have and ask as many questions as you want.

Some parents find that learning as much as they can about the condition helps them cope better. Talking to other parents in similar circumstances can also help reduce feelings of anxiety and isolation.

Psychological impact in children

A cleft lip and palate can also have a psychological impact on a child, particularly as they get older and begin to mix with other children.

Experts advise explaining the condition to your child as soon as they are old enough to understand. Treat it as a normal topic of conversation. The clinical psychologist in the team will be able to give further support with this.

You can also help strengthen your child's independence by involving them in the decision-making process about their treatment and their life in general.

If you are worried about your child's social or psychological development, speak to your specialist cleft nurse. They can arrange an assessment and any necessary counselling and support.

Feeding problems

Babies with a cleft may have problems feeding, particularly if the cleft includes the palate, as the baby may not be able to suck adequately.

However, feeding can usually be established quickly with assistance and sometimes the use of a special feeding bottle. Tube feeding is very unlikely unless there are also other feeding or swallowing difficulties.

Hearing

Children with a 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.

It is therefore important that all children with a cleft palate have their ears and hearing checked regularly by an audiologist.

See glue ear for more information.

Cleft surgery

Surgery to repair the cleft lip and palate is generally successful and complications are uncommon.

Cleft lip repair is often carried out when a child is between three and four months old and cleft palate repair when they are between six and 12 months old. Sometimes the timing of surgery may be later if there are good medical reasons for delaying the surgery. The cleft team will discuss with you the appropriate timing of the surgery.

Healing after surgery is good in most cases however healing complications do occur occasionally such as a wound infection or opening of the palate repair line. If this occurs then further surgery may be required.

As the child grows, the palate usually continues to function well for speech. However if it does not, then the cleft team may recommend investigating the palate function further.

Speech and language problems

The roof of the mouth (palate) plays an important role in helping your child form sounds for speech.

If a cleft palate is not repaired with surgery, it will lead to speech problems when the child is older. The cleft palate is therefore carefully repaired before speech development starts and in most cases the child goes on to develop normal speech.

About half of all children with a repaired cleft palate will need speech therapy, and a small number may need further surgery. Over time, a specialist speech and language therapist will monitor the child’s speech development.

Dental health

A cleft lip and palate can cause changes to the structure of the mouth and lead to problems with the development of teeth, making children more vulnerable to tooth decay. It is therefore important for the child to have their teeth checked regularly and practice good oral hygiene.

Tooth decay

Children with clefts are more likely to develop tooth decay. This is partly due to crowding of the teeth, which makes it more difficult to keep them clean. The advice below may help reduce your child’s risk of developing tooth decay.

• Your child should have a regular dental check-up.
• Encourage your child to brush their teeth after every main meal. When they are at school, you could put a small tube of toothpaste and a toothbrush in their lunchbox.
• Using a fluoride mouthwash once a day will help protect your child’s teeth against decay.
• Limit the amount of sugary foods and drinks your child consumes, especially between meals, as these foods increase tooth decay.
• Limit the amount of starchy foods such as crisps, white bread and biscuits that your child eats, especially between meals, to lower the risk of tooth decay.

Read more information about dental health and looking after your child's teeth.