Cleft Palates Can Be Repaired, Overcome

Cleft palates and lips are the fourth most common birth defect in the United States, affecting one in 700 births, according to the Cleft Palate Foundation (CPF).

The birth defect occurs early in a woman's pregnancy, within the first 10 weeks, when the lips and palate are formed. It can affect both the palate and lips, or just the palate itself. A cleft lip means that the two sides of the upper lip have not joined; this defect often includes the bones of the upper jaw and the gum, the CPF says. A cleft palate means that there is an opening in the roof of the mouth where the palate did not join. More than 70 percent of infants born with a cleft lip also have a cleft palate.

Those at higher risk

A cleft palate and lip is more common among Asians and certain groups of American Indians, according to the March of Dimes Birth Defects Foundation. Boy infants are affected more often than are girl infants. A cleft palate alone is less common, and the risk seems to be the same for all racial groups. Girls are affected more often by the cleft palate alone than are boys.

Researchers aren't sure what causes a cleft palate and lip, but they suspect that genes may play a role, as well as certain medications, infections, illnesses, and tobacco and alcohol use during pregnancy. A deficiency in folic acid also may be a factor, the March of Dimes says. Children with a cleft palate alone are likely to have other birth defects; this is not the case with a cleft palate and lip. Genes may play a larger role in the cause of cleft palate alone.

Infants born with a cleft lip and palate usually have a difficult time breast-feeding. They are also at higher risk for middle ear disease. Fluid builds up in the middle ear, causing mild to moderate hearing loss, the March of Dimes says.

The cleft palate and lip can be repaired surgically, usually in two stages, the lip being repaired from about 1.5 to 3 months and the cleft palate between the ages of 9 and 18 months but usually by a year in healthy infants. Further surgery often is necessary as the child grows. A team of medical experts is involved in treating a child with a cleft palate and lip, the CPF says, because the defect can affect children's feeding, speech, dental development, appearance, and self-esteem.

Team offers support

Who's on the team? Usually it includes:

• An audiologist

• A pediatrician

• A geneticist

• A plastic surgeon

• A pediatric dentist

• An orthodontist

• A speech-language pathologist

• An otolaryngologist (a physician who specializes in treating the ear, nose, and throat)

• A social worker

• A psychologist or mental health expert

For parents, the first sign of the defect can be devastating, according to the CPF. That's when the health care team kicks into gear. The support of family needs to happen within hours of birth.

In those first trying hours, team members explain that:

• Treatment for this condition has improved immensely in recent decades. Today, every child born in the United States is within easy reach of a cleft palate team.

• Genetic factors may contribute to cleft lip and palate.

• Surgery to close a cleft lip usually happens within 10 to 15 weeks of birth. Palate repair takes place at 9 to 18 months. If problems remain after that, a team works with the child until maturity to correct them.

Parents can take more than a little comfort in the sophisticated surgical techniques that help restore the balance of the face so it doesn't remain an object of unnecessary or undesired attention or concern.

For more information, visit the Cleft Palate Foundation Web site at www.cleftline.org.