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CLEFT PALATE

804-828-3042
craniofacial@mcvh-vcu.edu
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illustration of baby with cleft palateWhat is Cleft Palate?

A cleft is an opening or gap in the palate (roof of the mouth). It can range from a very small opening in the back to a much larger opening affecting almost the entire roof of the mouth. 

Cleft palate occurs during the first trimester of pregnancy, often before a woman knows she is pregnant.  It is one of the most common birth differences in the USA.

What Causes Cleft Palate?

In about two thirds of children, there is no known cause for their cleft.  Sometimes, clefts may run in families, or may be associated with other problems and may be part of a syndrome. A syndrome is a disorder that has a recognized group of symptoms or features. We have learned there are many things that can increase the chances of a baby having a cleft, but more still needs to be learned through research.

A specialist in the field of genetics helps families understand the possible causes of clefts. It is important for every family with a baby with a cleft palate to meet with a medical geneticist. We will help set up this appointment for you. 

Is Feeding Difficult For Babies With Cleft Palate?

photoBabies with cleft palate may have a hard time feeding. Because of the cleft, or opening between the mouth and nose, the baby can not generate the suction needed to pull milk from the bottle or breast. It is like trying to drink through a straw with a hole in it. This makes it difficult to breastfeed or use a regular bottle. Babies may look like they are nursing and sucking but they are really using up a lot of energy and getting very little milk. 

Our feeding specialist will evaluate your baby and determine which feeding system is best suited for your child. We will also provide you with a starter supply and a list of resources where you can obtain more bottles and nipples. Mothers are encouraged to express their breast milk to use in bottle feeding. Learn more about the Center's Feeding Consultation services.

Your baby may have milk come out of the nose. This is called “nasal regurgitation” and is not dangerous. It does not mean your baby is choking. Holding your baby in a more upright position during feeding can help decrease the amount of milk out the nose.  There is no need to use a bulb syringe to suck milk out of the nose—the nose clears and cleans itself.  A baby with a cleft palate may also swallow more air while feeding.  Burping your baby more frequently ensures the baby is comfortable.

What Other Areas are Affected by Cleft Palate?

The muscles in the palate normally help the middle ear to drain and stay healthy.  Because of the cleft, these muscles may not work properly and fluid can build up in the middle ear.  For this reason, babies with cleft palates often do not pass their newborn hearing screen.  This does not mean your child can not hear.  Our hearing specialist will follow your baby and perform further evaluation if needed.

Speech may also be affected by the cleft.  The palate separates the mouth and the nose area to allow normal speech.  You will notice that your baby’s babbling will sound more nasal.  Some sounds are affected more than others – “mama” will sound clear, but “dada” may sounds nasal (like “nana”).  After the palate is repaired, this will improve. 

How Is Cleft Palate Treated?

Our team recommends that every baby with cleft palate be evaluated while in the hospital, or as soon as possible after going home.  We ask each family with a newborn with a cleft palate to have their baby weighed once a week, on the same set of scales, and call us with the information. A two week follow up appointment will be scheduled by our clinic coordinator. We encourage families to call us with any questions or concerns.

The surgeon will determine the earliest and safest time for repair of the cleft palate, which is usually between 6 and 12 months of age.  The surgery rearranges the muscles at the back of the palate (“soft palate”) and the tissue of the hard palate to close the cleft. The surgeon does not take tissue from other parts of the body or use any artificial material to close the palate.  During the procedure, an ear specialist will examine your baby’ ears and place tiny drainage tubes if necessary.

Taking care of a child with a cleft palate is more than just performing a surgical procedure.  All children with cleft palate are followed regularly by our multidisciplinary team.  Experts dedicated to the care of children with craniofacial conditions from a wide range of pediatric specialties work together to make sure your child gets the best care possible.

»» Learn more about our Cleft Lip & Palate team of specialists.