Cleft lip and cleft palate are among the most common birth differences affecting the face and mouth, and they can be very surprising for families meeting their baby for the first time.
With timely treatment, ongoing care, and emotional support, most children with cleft lip and/or cleft palate grow up to eat, speak, and thrive just like their peers.
What Are Cleft Lip and Cleft Palate?
During early pregnancy, the tissues of a baby’s face and mouth are supposed to grow toward one another and join, forming a continuous upper lip and roof of the mouth. Cleft lip or cleft palate occurs when some of these tissues do not fully come together, leaving an opening or split.
A cleft lip is an opening in the upper lip, while a cleft palate is an opening in the roof of the mouth; a baby may have one or the other, or both at the same time.
Types of clefts
- Cleft lip only: A gap in the upper lip that may be small or extend up toward the nose.
- Cleft palate only: A gap in the palate (roof of the mouth), which can involve the hard palate (front), the soft palate (back), or both.
- Cleft lip and palate: An opening in both the upper lip and palate, sometimes extending through the gum where the teeth grow.
- One-sided (unilateral) cleft: The opening affects one side of the lip or palate.
- Two-sided (bilateral) cleft: The opening affects both sides of the lip or palate.
How Common Are These Conditions?
Cleft lip and cleft palate are among the most frequently seen birth differences involving the face, occurring in thousands of babies each year worldwide.
The exact rate varies by country and population, but health organizations recognize these conditions as major public health priorities because they require coordinated surgical and developmental care.
Why Do Cleft Lip and Cleft Palate Happen?
Families often wonder whether they did something wrong during pregnancy, but in most cases, no single action causes a cleft and there is no clear reason to blame.
Research suggests that cleft lip and cleft palate usually result from a combination of genetic tendencies and environmental influences that affect the way the baby’s face forms early in pregnancy.
Factors that may contribute
- Genetic influences: A family history of cleft lip or palate, or certain genetic syndromes, can increase the likelihood that a baby will have a cleft.
- Pregnancy exposures: Use of some medications such as certain anti-seizure drugs, heavy alcohol use, or exposure to specific chemicals during pregnancy has been linked with a higher risk in some studies.
- Maternal health factors: Smoking, poorly controlled medical conditions, and lack of folic acid are associated with increased risk in some populations.
- Unknown causes: For many babies, no risk factors are found, and the cleft is considered a sporadic event.
Even when risk factors are present, they do not guarantee that a cleft will occur; they simply shift the odds slightly.
How Cleft Lip and Palate Are Diagnosed
Sometimes cleft lip is seen before birth on a routine pregnancy ultrasound, especially when the opening is larger, while cleft palate alone is usually not visible until after the baby is born.
After delivery, the medical team examines the baby’s mouth, nose, and face to confirm the type and extent of any cleft and to plan appropriate follow-up care.
Additional evaluation
- Assessment by a pediatric specialist or craniofacial team.
- Hearing checks, because children with cleft palate are more prone to middle ear fluid and hearing loss.
- Growth and feeding assessments to make sure the baby is gaining weight and staying healthy.
Early Challenges: Feeding, Breathing, and Growth
In the newborn period, the most urgent concern is usually feeding, since babies with cleft palate may have trouble creating suction to draw milk from the breast or bottle.
Some infants also have issues with nasal regurgitation (milk coming out through the nose) or, less commonly, breathing difficulties if the jaw and tongue are also affected.
Practical feeding strategies
- Using specialized bottles or nipples that allow milk to flow more easily without strong suction.
- Holding the baby more upright during feeds to reduce milk entering the nose and to support breathing.
- Allowing more frequent, shorter feeds to reduce exhaustion and help with weight gain.
- Working with feeding or lactation specialists who have experience with cleft conditions.
With the right equipment and guidance, many babies with clefts are able to grow well while waiting for surgery.
Common Health Issues Linked to Cleft Palate
Because the palate plays a role in hearing, speech, and dental development, children with cleft palate often need ongoing attention in these areas even after surgical repair.
Early detection of related problems makes treatment more effective and helps children stay on track with their peers.
| Area | Potential Concern | Typical Support |
|---|---|---|
| Hearing | Frequent middle ear fluid and risk of hearing loss. | Ear tubes, hearing tests, and follow-up with ear, nose, and throat specialists. |
| Speech | Nasal-sounding speech, unclear words, or delayed speech sounds. | Speech therapy, ongoing monitoring, and sometimes additional palate surgery. |
| Teeth and bite | Missing, crooked, or extra teeth; misaligned jaws. | Dental care, orthodontics, and sometimes bone grafting to the gum area. |
| Growth and nutrition | Difficulty gaining weight in infancy due to feeding challenges. | Special feeding plans, high-calorie nutrition, and growth monitoring. |
