A comprehensive guide to cleft palates

Clefts are more common than you may imagine, and untreated can lead to life-long complications.

03 July 2019
By Glynis Horning

Learn about them in National Cleft Palate and Craniofacial Awareness and Prevention Month.

What are cleft palates?

Clefts are gaps left in a baby’s lip, hard or soft palate where tissues don’t fuse as they should in the first few months of pregnancy. They’re one of the most common types of birth defect, affecting about one in 500 to 1 000 births, reports Operation Smile South Africa, a non-profit volunteer organisation that provides free surgeries to repair these malformations for needy children. 

Usually, the cleft is obvious, as when it affects the lip or hard front palate (roof of the mouth), but it may go unnoticed if it’s in the soft palate, which lies further back and is covered by mucous membrane.

Depending on the type and severity of cleft, if left untreated it can create serious health problems – from difficulty feeding (which can lead to malnutrition), to problems with tooth development and alignment, impaired language and speech development, and problems hearing, as fluid can build in the middle ear, causing chronic ear infections and hearing loss. 

These problems, in turn, can lead to low self-esteem, bullying, withdrawal, social isolation and depression, all of which makes it vital to get help early.

What are the treatment options for a cleft palate?

Treatment requires surgery from an early age, and often multiple surgeries. “Ideally, and in the absence of any medical reason not to do surgery, a cleft lip should be repaired at three or four months of age, and a cleft palate, between 12 and 18 months,” says Dr Paul Skoll, a volunteer cleft surgeon for Operation Smile. 

Children with cleft palates may also require squeeze bottles that help fluids flow downwards, and occasionally grommets placed in their eardrums to help drain their middle ears, if there’s fluid build-up. Many also need other types of treatment too, from special dental care to speech therapy, and where they have emotional or behavioural problems, counseling and support. 

With the right care, children with clefts can go on to lead normal, healthy lives, but the surgical and other procedures can be complex and expensive, which is where Operation Smile comes in, helping children where it can by offering free, safe and comprehensive surgery.

What causes cleft palates in babies?

Prevention is not possible, as in most cases the cause of clefts is unknown. There seems to be a small genetic connection, as there’s slightly more chance (4-5% more than in the general population, says Skoll) of clefting in a baby if a sibling, parent or other relative has had the problem. Clefts may also be related to exposure to viruses or chemicals in the womb, or to medication taken by the mom in pregnancy, such as anti-seizure drugs or anti-convulsants (for epilepsy), acne drugs with Accutane, and methotrexate (used often to treat arthritis, psoriasis and cancer). 

“Taking 5mg daily of folic acid when planning pregnancy, and for at least the first trimester, will help lessen the risk of neural crest clefts, including cleft lip and palate and spina bifida,” says Skoll.

Is there anything you can do to reduce your baby's risk of a cleft palate?

There are also other things you can do to help keep your risk of having a baby with a cleft as low as possible:

  • If you have a family history of clefts, ask your healthcare practitioner about getting genetic counseling to help determine your risk of having a baby who’s affected.
  • If you smoke or drink, stop – preferably before trying for a baby. Recent research by the US Centres for Disease Control suggests women who smoke in early pregnancy are more likely to have a baby with an orofacial cleft. 
  • If you’re obese, overweight or diabetic, take special care of your health in pregnancy, as some research (for example, in the journal Paediatric and Perinatal Epidemiology) suggests there may be a slightly higher chance of having a baby with a cleft. If possible, shed excess weight before trying to conceive. 
  • Eat a healthy, balanced diet, preferably starting before conception – poor nutrition can affect the healthy development of a baby, notes Operation Smile.
  • As soon as you plan to get pregnant, tell your healthcare practitioners and your pharmacist, so you aren’t put on medications that may harm your developing baby. “The face is largely completely formed by eight weeks gestation, and what you take in that time may affect it,” says Skoll.

If you have a child with a cleft palate, for parental support contact Cleft Friends, 0861 ASMILE (toll free), a project of the Smile Foundation.

To support Operation Smile, visit http://southafrica.operationsmile.org. They can repair a child or adult’s cleft lip or palate (depending on the pre-surgery check-up) in just 45 minutes, and for as little as R5 500. Donating can help change someone’s future.

IMAGE CREDIT: 123rf.com