Health A to Z
A cleft is a gap or split in the upper lip and/or roof of the mouth (palate). It is present from birth.
The gap is there because parts of the baby's face didn't join together properly during development in the womb.
A cleft lip and palate is the most common facial birth defect in the UK, affecting around one in every 700 babies.
This page covers:
Babies can be born with a cleft lip, a cleft palate, or both.
A cleft lip may just affect one side of the lip or there may be two clefts.
It can range from a small notch to a wide gap that reaches the nose.
A cleft palate may just be an opening at the back of the mouth, or it may be a split in the palate that runs all the way to the front of the mouth.
Sometimes it can be hidden by the lining of the roof of the mouth.
The Cleft Lip and Palate Association has a photo gallery with pictures of cleft lips and palates before and after surgery.
Cleft lips and cleft palates can sometimes cause a number of issues, particularly in the first few months, before surgery is carried out.
Problems that can occur include:
Most of these problems will improve after surgery and with treatments such as speech and language therapy (see Treatments below).
A cleft lip or palate happens when the structures that form the upper lip or palate fail to join together when a baby is developing in the womb.
The exact reason why this doesn't happen in some babies is often unclear. It's very unlikely to have been the result of anything you did or didn't do during pregnancy.
In a few cases, cleft lip and palate is associated with:
In some cases, a cleft lip or palate can occur as part of a condition that causes a wider range of birth defects, such as 22q11 deletion syndrome (sometimes known as DiGeorge or velocardiofacial syndrome) and Pierre Robin sequence.
Cleft lips are usually picked up during the mid-pregnancy anomaly scan carried out when you're between 18 and 21 weeks pregnant. Not all cleft lips will be obvious on this scan and it's very difficult to detect a cleft palate on a routine ultrasound scan.
If a cleft lip or palate doesn't show up on the scan, it's normally picked up immediately after birth or during the newborn physical examination done within 72 hours of giving birth.
When a cleft lip or palate is diagnosed, you'll be referred to a specialist NHS cleft team who will explain your child's condition, discuss the treatments they may need and answer any questions you have.
You may also find it useful to contact a support group, such as the Cleft Lip and Palate Association, who can offer advice and put you in touch with parents in a similar situation.
Cleft lips and cleft palates are treated at specialist NHS cleft centres.
Your child will usually have a long-term care plan that outlines the treatments and assessments they're likely to need as they grow up.
The main treatments are:
Read more about how cleft lip and palate is treated.
The majority of children treated for cleft lip or palate grow up to have completely normal lives.
Most affected children won't have any other serious medical problems and treatment can normally improve the appearance of the face and resolve issues such as feeding and speech problems.
Surgery to repair the cleft may leave a small pink scar above the lips. This will fade over time and become less noticeable as your child gets older.
Some adults who've had a cleft lip or palate repair may be self-conscious or unhappy about their appearance. Your GP may refer you back to an NHS cleft centre for further treatment and support if there are any ongoing issues.
Most cleft lips and palates are a one-off and it's unlikely you'll have another child with the condition.
The risk of having a child with a cleft lip or palate is slightly increased if you've had a child with the condition before, but the chances of this happening are thought to be around 2-8%.
If either you or your partner were born with a cleft, your chance of having a baby with a cleft is also around 2-8%. Most children of parents who had a cleft will not be born with a cleft.
The chances of another child being born with a cleft or of a parent passing the condition to their child can be higher in cases related to genetic conditions.
For example, a parent with 22q11 deletion syndrome (DiGeorge syndrome) has a 50% chance of passing the condition to their child.
Children with a cleft lip or palate may need several treatments and assessments as they grow up.
The cleft is usually treated with surgery. Other treatments, such as speech therapy or dental care, may be needed for associated symptoms.
Your child will be cared for by a specialist multidisciplinary cleft team within an NHS cleft centre.
This page covers:
Children with clefts will have a care plan tailored to meet their individual needs. A typical care plan timetable for cleft lip and palate is described below:
Your child will also need to attend regular outpatient appointments at the cleft clinic so their condition can be monitored closely and any problems can be dealt with.
These will usually be recommended until they're around 21 years of age, when they're likely to have stopped growing.
Lip repair surgery is usually carried out when your child is around three months old.
Your child will be given a general anaesthetic (where they're asleep) and the cleft lip carefully repaired and closed with stitches.
The operation usually takes one to two hours.
Most children are in hospital for a day or two. Arrangements may be made for you to stay with them during this time.
The stitches are removed after a few days or may dissolve on their own depending on the type of stitches used.
Your child will have a slight scar, but the surgeon will attempt to line up the scar with the natural lines of the lip to make it less noticeable. It should fade and become less obvious over time..
Palate repair surgery is usually carried out when your child is 6-12 months old.
The gap in the roof of the mouth is closed and the muscles and the lining of the palate are rearranged. The wound is closed with dissolvable stitches.
The operation usually takes about two hours and is carried out under general anaesthetic. Most children are in hospital for one to three days, and again arrangements may be made for you to stay with them.
The scar from palate repair will be inside the mouth.
In some cases, additional surgery may be carried out at a later stage to:
Many babies with a cleft palate have problems breastfeeding because of the gap in the roof of their mouth.
They may struggle to form a seal with their mouth – so they may take in a lot of air and milk may come out of their nose. They may also struggle to put on weight during their first few months.
A specialist cleft nurse can advise on positioning, alternative feeding methods and weaning if necessary.
If breastfeeding isn't possible, they may suggest expressing your breast milk into a flexible bottle that is specially designed for babies with a cleft palate.
Very occasionally, it may be necessary for your baby to be fed through a tube placed into their nose until surgery is carried out.
Children with a cleft palate are more likely to develop a condition called glue ear, where fluid builds up in the ear.
This is because the muscles in the palate are connected to the middle ear. If the muscles aren't working properly because of the cleft, sticky secretions may build up within the middle ear and may reduce hearing.
Your child will have regular hearing tests to check for any issues.
Hearing problems may improve after cleft palate repair and, if necessary, can be treated by inserting tiny plastic tubes called grommets into the eardrums. These allow the fluid to drain from the ear.
Sometimes, hearing aids may be recommended.
Read more about treating glue ear.
If a cleft involves the gum area, it's common for teeth on either side of the cleft to be tilted or out of position. Often a tooth may be missing, or there may be an extra tooth.
A paediatric dentist will monitor the health of your child's teeth and recommend treatment when necessary. It's also important that you register your child with a family dentist.
Brace treatment usually starts after all the baby teeth are lost, but may be necessary before the bone graft, to repair the cleft of the gum.
Repairing a cleft palate will significantly reduce the chance of future speech problems, but in some cases, children with a repaired cleft palate still need some form of speech therapy.
A speech and language therapist (SLT) will carry out several assessments of your child's speech as they get older.
If there are any problems, they may recommend further assessment of how the palate is working and/or work with you to help your child develop clear speech. They may refer you to community SLT services nearer to your home.
The SLT will continue to monitor your child's speech until they are fully grown and they will work with your child for as long as they need assistance.
Further corrective surgery may sometimes be required for a small number of children who have increased airflow through their nose when they're speaking, resulting in nasal-sounding speech.