Children born with cleft lip and palate may have difficulty with feeding, speaking and hearing. I work very closely with a team of specialists and families to make sure these children get the special attention they need, while young. When I see a baby with a cleft lip or palate, I know I will get to know the child and their family very well and look forward to developing that relationship.

What are cleft lip and palate?

Cleft lip and palate are birth defects of the mouth and lip. A normal fetus has a split lip and palate, but early in pregnancy, the sides of the lip and the roof of the mouth fuse. Failure of fusion results in cleft lip and/or cleft palate.

• About 6,000 to 8,000 kids are born in the United States with oral-facial clefts every year
• Cleft defects are more common in boys
• Cleft defects are more common in Asians and certain groups of American Indians and are less common in African-Americans
• Less than 13 percent of patients have other birth defects

What is cleft lip?

Cleft lip is an abnormality in which the lip does not completely form during fetal development. The cleft may be one sided or on both sides. The degree of the cleft lip can vary greatly, from mild (notching of the lip) to severe (large opening from the lip up through the nose), in which case the cleft can be very noticeable.

What is cleft palate?

Cleft palate occurs when the roof of the mouth does not completely close during fetal development, leaving an opening that can extend into the nasal cavity. The cleft may involve either side of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). Often the cleft will also include the lip.

Cleft palate is not as noticeable as cleft lip because it is inside the mouth. It may be the only abnormality in the child, or it may be associated with cleft lip or other syndromes. In many cases, other family members have also had a cleft palate at birth.

Children can also have a less noticeable form of cleft palate, known as a submucous cleft palate. This is a cleft covered by the mucous membrane that lines the roof of the mouth. This may not present difficulties or be recognized until later in childhood.

What are some causes of cleft lip and palate?

A combination of genetic and environmental factors contributes to cleft lip and palate. If parents without clefts have a baby with a cleft, the chance they will have another baby with a cleft ranges from 2 percent to 8 percent, which suggests a genetic factor. If clefts run in your family, genetic consultation is recommended. In addition, there are several syndromes commonly associated with cleft lip and palate. Most often cleft lip and palate occur in babies with family history.

What are some challenges for children with cleft lip and/or palate?

Beyond the cosmetic abnormality, there are other possible complications that may be associated with cleft lip and cleft palate.

Feeding difficulties

Frequently, the most immediate concern for a baby with a cleft palate is proper nutrition. Sucking is difficult for a child with cleft palate because the roof of the mouth is not formed completely, making it difficult for your baby to create enough suction to pull milk from a standard bottle or the breast. Your baby may appear to be working very hard at feeding, but end up taking only a very small amount of breast milk or formula. When this happens, your baby does not gain weight properly and may require readmission to the hospital. Feeding difficulties occur more with cleft palate abnormalities. Children with cleft lip but without cleft palate do not usually have feeding difficulties.

Issues of extra air intake and nasal regurgitation (milk coming from the nose) may also occur. With proper teaching, support and patience, most babies with cleft palate go on to do very well with feeding. In some cases, extra support from a feeding team may be recommended. Contact *** for resources that can help with feeding your baby with a cleft palate.

Ear infections and hearing loss

Patients with cleft palate in particular are more susceptible to ear infections due to a dysfunction of the tube that connects the middle ear and the throat, causing fluid collection behind the ears.

Recurrent infections can lead to hearing loss, so patients with cleft palate may require the surgical placement of ventilating tubes in the eardrum to prevent fluid build-up and lessen the occurrence of ear infections and associated hearing loss. These tubes are often placed at the time of cleft lip or palate repair, and may need to be replaced as necessary to preserve normal hearing.

Speech and language delay

Due to the opening of the roof of the mouth and the lip, muscle function may be decreased, which can lead to delayed or abnormal speech. Speech therapy with our team is a vital component to care for the child with cleft lip or palate.

Cosmetic deformity

As your child grows, he or she might develop irregularities or asymmetries in the face, either due to clefting or abnormal facial growth. We can help to maximize normal appearance through surgery and other treatments.

Difficulties with nasal breathing

It is not uncommon for some children to have a deviated septum, a problem that can cause significant functional impairment. Dr. Kopelovich can straighten the septum and help restore the nasal airway.

Dental problems

As a result of the abnormalities, teeth may not erupt normally and orthodontic treatment is usually required. Dr. Kopelovich works with board-certified pediatric orthodontists and pediatric dentists as part of his cleft lip and palate team.

Diagnosis

Early diagnosis and treatment is important to achieve optimal outcomes and correction of cleft lip and palate. The discovery of cleft lip and cleft palate while a baby is still in utero allows both the family and the healthcare team to prepare, anticipate potential challenges and assemble appropriate resources to help your newborn.

Cleft abnormalities are most often prenatally diagnosed around or after 30 weeks gestation. At this stage of fetal development, the lip and palate have normally fused, so a failure to fuse may be evident in advanced prenatal imaging tests after this time.

Diagnosis of a birth defect like cleft lip and palate is a challenging time for any family. Together with other specialists Dr. Kopelovich’s team provides a wide range of resources to support families through-out pregnancy, delivery, and treatment after birth.

Treatment

Children with cleft lip and cleft palate receive coordinated care through our Cleft Lip and Palate Program. The multidisciplinary program brings together plastic surgeons, pediatric otolaryngologists, pediatricians, orthodontists and other specialists in order to provide the most comprehensive care for your child.

The interventions required for each patient with cleft lip and palate will vary depending upon the type and severity of the deformity. Timing and treatment will be adjusted based on each patient’s overall medical needs.

Long term care

After successful repair of cleft lip and/or cleft palate, patients will return to our clinic for yearly appointments that  include meetings with specialists, an overall health assessment, and surgical follow-up. Once a patient reaches maturity and completes all of the procedures and treatment, s/he is generally discharged from annual clinic visits.

From the moment your child enters our program, our multidisciplinary team partners with your pediatrician or primary care physician to provide coordinated care, making treatment recommendations according to each patient’s unique needs.

Our program brings together a variety of pediatric specialists, all with extensive experience treating children with cleft lip and palate. Your child’s long-term care will include:

Speech and language assessments

Our speech pathologists work with the surgical and medical team to plan individualized treatment needed to improve your child’s communication skills and make recommendations for speech therapy or surgery as needed.

A speech and language pathologist will evaluate your child’s feeding skills and oral-motor development shortly after birth. Our team will later partner with your pediatrician to monitor for delays in speech and language development, and make any appropriate referrals for early intervention.

When children have the ability to follow directions and speak in sentences (around three years of age), we begin yearly speech and language evaluations during clinic visits to assess function of the palate. Due to changes in the growth of the face and oral structures as your child grows, routine evaluations continue through the teen years to monitor language development, articulation and vocal quality.

Audiology assessments

A hearing specialist will document repeated ear infections or hearing loss that frequently accompany cleft palate.  Dr. Kopelovich may recommend the surgical placement of ventilating tubes in the eardrum to prevent fluid build-up and lessen the occurrence of infections and hearing loss.

Dental and orthodontic care

Our dental and orthodontic specialists keep track of your child’s dental growth and development, making recommendations regarding proper care for teeth as well as the timing of any necessary surgical procedures or corrective orthodontics.