Cleft Lip and Palate

Cleft lip and palate are among the most common birth defects, occurring when the tissues forming the lip or the roof of the mouth do not join completely during early pregnancy. They are treatable with surgery, and most children go on to develop normally.

• A visible gap or split in the upper lip, ranging from a small notch to a wide opening extending to the nose
• A gap in the roof of the mouth (palate), which may occur with or without a cleft lip and is not always visible without examination
• Difficulty feeding, as the gap can make it hard for the infant to create suction while breastfeeding or bottle feeding
• Nasal regurgitation of milk during feeding when the palate is affected
• Speech and hearing difficulties can develop later in childhood if the palate is affected and not treated

• Results from incomplete joining of the facial tissues that form the lip and palate during early pregnancy.
• Often no specific cause is identified in an individual case, though a combination of genetic and environmental factors is thought to contribute.
• Risk may be increased by certain maternal exposures during early pregnancy, such as smoking or specific medicines, and by family history of cleft lip or palate.

• Often visible at birth on examination, or occasionally detected on antenatal ultrasound.
• A cleft palate without a visible lip cleft may be identified through examination of the infant's mouth, which should be routinely checked at birth.
• Assessment for feeding difficulty is an important early step, given the challenges these defects can pose for breastfeeding.

Surgical repair of the lip and/or palate is the definitive treatment, generally performed in specific stages during infancy and early childhood according to established timing guidelines.

Specialised feeding support, including specific feeding techniques or equipment, helps ensure adequate nutrition and growth before surgery, particularly for infants with a palate cleft who have difficulty creating suction.

Ongoing multidisciplinary care — including speech therapy, dental and orthodontic care, and hearing assessment — supports normal development through childhood, particularly for children with palate involvement.

With appropriate surgical and supportive care, most children with cleft lip and palate go on to have normal speech, feeding, and appearance.

• Ensure good antenatal care, and avoid smoking and unnecessary medicines during pregnancy.
• Seek early referral to a cleft team or specialist service once a cleft is identified, ideally soon after birth, for feeding support and surgical planning.
• Attend all recommended follow-up appointments for the staged surgical and developmental care these children need through childhood.
• Seek support from family and cleft-specific support services, as ongoing care extends over many years.