Cleft palate is one of the most common birth defects in the United States. Cleft palate is a separation in the roof of the mouth that occurs when it fails to join, or fuse, as a child is developing before birth.

Dental, speech, feeding and hearing problems may result from this condition.

Surgery to correct a cleft palate is usually done between 9 months and 2 years of age, and may require several stages of repair.

Causes of Cleft Palate

No single cause of cleft palate has been identified. Certain risk factors may increase chances of cleft palate.

• Genetic factors
• Smoking during pregnancy
• Diabetes
• Substance abuse

Diagnosis of Cleft Palate

Cleft palate is usually diagnosed at birth. Sometimes the condition is identified before birth on an ultrasound. If the cleft palate is hard to see, you may notice that your baby has trouble feeding.

Because of the cleft palate, babies are unable to suck or nurse effectively. In most cases you will need to use special feeding techniques and / or special bottles and cups for your baby.

Preparing for Cleft Palate Surgery

Repair of cleft palate (palatoplasty) is usually performed between 9 months and 2 years of age. Palate repair may require several stages of repair.

In preparation for the palate repair the infant must be off a bottle and pacifier and only drinking from a cup. We will schedule a special visit before your child’s surgery to help you learn how to transition them to cup feeding. You may need to wean your baby off of a bottle as early as 6 months of age.

Cleft Palate Treatment Timeline

This is a timeline for treatment of the child with a cleft palate. This timeline provides you with a general treatment plan overview. Each child with a cleft palate is unique and will have their own treatment plan.

Birth-2 Months

Your baby will see a plastic surgeon in their first month. 

What to expect at this visit:

The team will:

• Ask questions about your family history and your pregnancy
• Weigh your baby
• Take photos of your baby
• Review the best treatment plan for your baby

6 Months

• It is time to get your baby ready for their cleft palate repair.
• Teach them to drink from a regular cup – not a sippy cup.
• When the cleft palate is repaired, your child will have stitches in the roof of their mouth. Using a sippy cup or pacifier (or anything that makes them use a sucking motion) can irritate the stitches.
• Follow-up with your plastic surgeon.
• Meet your ENT surgeon for evaluation for ear (PE) tubes.

9 Months

• The cleft palate is repaired.
• If your baby hasn’t had ear (PE) tubes placed, they are inserted during this surgery
• Your baby will stay one to two nights in the hospital and need to wear arm restraints to keep them from putting anything in their mouth.
• Your baby will go home when they are able to drink enough fluids.

3-5 Years Old

• When your child begins to speak in sentences, a speech pathologist will evaluate their speech. Speech therapy and / or surgery may be needed.
• If surgery is needed, your child will return to see a plastic surgeon that will perform speech surgery.
• Your child will usually stay in the hospital two to four days after surgery until they are drinking well.

Care After Cleft Palate Surgery

You will need to protect your child’s palate from injury while it is healing. It is hard to tell how much feeling your child has in the repaired palate. The tissue may be numb and without feeling for a period of time after surgery. If this is the case, it is possible for your child to injure the roof of their mouth without feeling any pain. You may treat your child as any other child but you must watch them closely to keep hands and objects out of their mouth.

Your baby will have elbow restraints for one to two weeks after surgery (physician dependent) to keep hands away from the surgical site. Remove the restraints to exercise the arms. Remove one restraint at a time, on a rotating basis, every hour or so to exercise and massage the arms. Make sure to watch your child closely when the elbow restraint is off.

Diet After Cleft Palate Surgery

• You may feed your child formula from a cup only after the operation.
• Mix baby food with fluid in a cup so it is able to be poured. Parent-directed spoon feeding is appropriate. The child should not control the spoon, and the tip of the spoon should not go past the gum line to prevent injury to the repair.
• Make sure food is not too hot.
• Provide fluids from a cup only and do not use straws.
• After the meal, give your child water to help keep the mouth clean of food.

Prognosis

Possible long-term problems include speech problems, crooked teeth, frequent head colds and frequent ear infections.

Call Your Child's Doctor If:

• The child refuses to eat or has a decrease in wet diapers
• The child has a fever over 100.4°
• You have any questions or concerns