Cleft Palate – Causes, Symptoms, Complications and Treatment

Cleft Palate/ lip usually occurs when the tissues of the lip/mouth are not formed properly during the early years of the baby. A connection between the nasal cavity and the mouth is observed in the form of a hole, which is known as the cleft palate.

It is a gap between both lips, which cannot be joined together. A cleft lip or palate can be seen together or separately in a newborn baby. Kids who have a cleft lip can also have a cleft palate. If the tissue that makes up the front portion of the mouth fails to join together during pregnancy, it will result in a cleft palate. For some, the palate might be open from both back and front, while others might be a single opening.

If it is only a cleft lip, then the baby will not suffer any speech difficulties and feeding. However, if it is a cleft palate, the baby might have to undergo surgery to avoid speech difficulty or any feeding difficulty 

Request an appointment at Apollo Hospitals

Will a baby with a cleft palate/lip face any complications while trying to talk?

About 20% of kids who have a cleft palate require further surgeries to help improve their speech. But in the long run, speech generally improves with time. There might be a few cases when kids can develop speech problems even after the palate has been treated. Consult a speech-language pathologist who will carefully listen to the child’s speech to help surgeon decide if another surgery is required to improve speech.

What are the causes of the cleft palate?

When parts of the roof of your mouth do not come together during pregnancy, a cleft palate occurs. There is no particular cause behind this, but according to doctors, it can occur because of genetics or external environmental factors.

Some other causes include:

• Exposure to chemicals during pregnancy
• Taking medications (like anti-seizure) when pregnant
• Not getting enough prenatal-nutrients
• Using harmful substances like cigarettes, alcohol, and drugs in pregnancy.

What are the complications that babies face due to cleft lip/ palate?

There can be several complications due to cleft lip/ palate. Some of them have been mentioned below:

• Babies with a cleft palate may be more prone to hearing deficiencies due to an ear infection.
• Babies will have difficulty feeding.
• Some children with a cleft palate will have speech difficulties due to the structure of the palate. This usually improves with surgery. However, some children might need continuous speech therapy.
• Children with clefts may face social, emotional, and behavioral problems due to differences in appearance and the stress of intensive medical care.
• The child might develop hypernasality (too much air entering the nose) or nasal emission (air pushed through the nose).

What are the risk factors involving cleft palate?

There can be many risk factors due to which a child might develop a cleft lip or palate. Some of them include:

• Family history (genes)- If you had/ have a cleft palate running in your genes, there are high chances that your baby too will develop a cleft palate.
• If you have diabetes while you are pregnant, there are very high chances that your child might develop a cleft lip irrespective of the fact that they’ll develop a cleft palate too or not.
• There is some evidence that a baby born to an obese mother may have a higher chance of developing a cleft palate or lip.
• If the mother-to-be uses any harmful substances like cigarettes, drugs, or alcohol during pregnancy, it might cause a cleft lip or palate.

What are the symptoms of having a cleft palate?

Generally, a split (separated) on the lip or the feeling of taste is quickly recognized during childbirth. Cleft palate and lip may show up as: 

• A split in the head of the mouth and the lip (feeling of taste) that impacts one or different sides of the face. 
• If there is a split in or near the lip that appears as a little indent in/near the lip or connects from the upper gum through the lip and feeling of taste into the lower part of the nose.
• A split in the head of the mouth that doesn’t impact the presence of the face 

It’s very rare that a cleft palate happens just in the area of the fragile feeling of taste, that is secured by the mouth’s covering and is generally at the head of the mouth. This sort of split habitually goes unnoticed during the birth and is not observed till the signs appear. Some of the symptoms of submucous cleft palate include: 

• Issue with feedings 
• Inconvenience in swallowing anything, which might result in liquids or food coming out of the nasal area.  
• Chronic ear disease

When to consult a doctor?

The following signs are a few symptoms which might be a signal for you to go for surgery for the cleft palate-

• If a child has a continuous fever above 101.4°F (38.5°C)
• If he/she has long-lasting pain or any sense of discomfort.
• If the child is bleeding heavily from the mouth or nose.
• If he/she refuses to drink any fluids.
• If they aren’t wetting their diapers.

Request an appointment at Apollo Hospitals

Call 1860-500-1066 to book an appointment

How can a cleft palate be prevented?

While in many cases a cleft lip/ palate can’t be prevented, the below-mentioned methods might be of some help to lower the risk.

• Taking prenatal vitamins only after consulting your doctor.
• Avoiding consumption of tobacco or alcohol during your pregnancy to avoid any birth defects in your baby.
• Prefer genetic counseling if a cleft palate is a hereditary complication in your family; your counselor will be able to tell you how much probability there is for your child.

How to diagnose a cleft palate?

When the doctors examine the inside of a newborn’s mouth, they take an oral examination and usually identify a cleft palate.

• Ultrasound is usually done to check for a cleft lip or palate. The doctor normally identifies if a cleft palate might develop. A cleft lip can be identified with the help of an ultrasound starting around the 13th week of pregnancy. As the fetus continues to mature, it gets easier to identify a cleft lip accurately. 
• If there is a possibility of a cleft during a prenatal ultrasound, the doctor may take a small sample of amniotic fluid from the uterus. This test will identify if there are any birth defects due to genetics. However, the actual reason behind why there is a cleft palate in some children is still unknown.

What are the treatment options for cleft palate? 

Treatment includes medical procedures to fix the defect and therapy to improve any connected conditions. The end goal of creating a cleft palate is the ease in speaking, eating, and hearing for a newborn.

The treatment to remove a cleft palate includes surgery and therapy that will improve the after-effects of the surgery.

A newborn with a cleft palate/lip can start early treatment to empower the rebuilding of as ordinary an appearance as conceivable before the kid starts maturing. The early treatment limits the social uneasiness a kid might feel as they develop.

Surgeries are performed in the order:

• Cleft lip repairs between the first 3 to 6 months
• Cleft palate repairs between the age of 12 months, or earlier
• Follow-up surgeries occur between age 2 and late teen years
• Dental treatment might be required for some children with cleft palate.

Many children might need additional surgeries when they grow up. These additional surgeries can improve the appearance of the face and might also improve hearing, breathing, and speech and language pattern. 

Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. 

How to manage post-surgery?

Once your kid’s surgery is complete and there are no more complications, they should be checked for their behavioural and personality changes (if any).

• If you observe any such changes, you can always consult a therapist for post-surgery trauma that your child might face. Because in situations like these, professional help will be beneficial.
• If you observe that your child’s speech is still not clear, then consult with a speech therapist who will check and see if any further surgery is required or not.
• Give some space to your child and tell them that you will always be by there if they face any difficulty because of this problem.
• To boost your child’s confidence again, you have to make some extra efforts and tell your kid to embrace their natural self and help them regain their self-esteem.

For some, this post-surgery experience can be traumatic, while it might not affect that much for others. It all depends from person to person. So, keep a check on your child and just be there for them.

Conclusion

The actual reason behind a kid developing a cleft palate or lip is still unknown, and all a parent of that kid can do is take early precautions, consult a doctor, and go for the option that is best suited. Because later on, a kid with a cleft palate might face societal pressure as well. So, it’s always better to take the necessary steps in the preliminary stage to avoid unnecessary issues in the future. It’s okay to take professional advice.

Frequently Asked Questions (FAQs)

Do I need to seek therapy after the surgery for my child?

An external help in therapy after surgery will help your child boost their self-esteem and confidence, which might be lost because of their being self-conscious about their physical appearance. Therapy will also help in reducing any post-surgery stress or anxiety that your kid might have. So, there is no harm in seeking therapy post-surgery.

What changes will my kid have to undergo after treatment?

You might have to change the following strategies post-treatment:

• Change the way you feed your baby, which can include using any sort of special bottle nipple or any feeder
• Opt for speech therapy that will eventually improve difficulty while conversing.
• Any sort of orthodontic adjustments to the teeth, for example, having braces
• Observation by a dentist to improve the development of tooth and oral health.
• Continuous evaluation for ear infections.
• Using hearing aids to overcome hearing loss (if any)
• Going for therapy by consulting a psychologist who will help the child to overcome the stress of repeated medical treatments or any other problems.

What are the other health conditions that the child might have?

A child might have other health problems, which might include:

• Breathing problem
• Frequent ear infections
• Trouble during feeding
• A rare chance of hearing loss
• Eye problems
• Speech difficulties

These conditions are not specific to every child and vary from person to person.