Cleft lip and palate


A cleft is agap or split in the upper lip and/or roof of the mouth (palate). It is present from birth.

The gap is there because parts of the baby's face didn't join together properly during development in the womb.

A cleft lip and palate is the most common facial birth defect in the UK, affecting aroundone in every 700 babies.

This page covers:

What does it look like?

Problems it can cause





Will it happen again?

What does a cleft lip and palate look like?

Babies can be born with a cleft lip, a cleft palate, or both.

Acleft lip may just affect one side of the lip or there may be two clefts.

It can range from a small notch to awide gap that reaches the nose.

Acleft palate may just be an opening at the back of the mouth, or it may be a split in the palate thatruns all the way to the front of the mouth.

Sometimes it can be hidden by the lining of the roof of the mouth.

The Cleft Lip and Palate Association has a photo gallery with pictures of cleft lips and palates before and after surgery.

Problems related to cleft lip and palate

Cleft lips and cleft palates can sometimes cause a number of issues, particularly in the first few months, before surgery is carried out.

Problems that can occur include:

  • difficulty feeding babies with a cleft palate may be unable to breastfeed or feed from a normal bottlebecause they can't form a good seal with their mouth
  • hearing problems some babies with a cleft lip are more vulnerable to Otitis media and a build-up of fluidin their ears (glue ear) , which may affect theirhearing
  • dental problems a cleft lip and palate can mean a child's teeth don't develop correctly and they may be at a higher risk of tooth decay
  • speech problemsif a cleft palate isn't repaired, itcan lead to speech problems such as unclear or nasal-sounding speech when a child is older

Most of these problems will improveafter surgery and with treatments such as speech and language therapy (see Treatments below).

Causes of cleft lip and palate

A cleft lip or palate happens when the structures that form the upper lip or palate fail tojoin together when a baby is developing in the womb.

The exact reason why this doesn't happen in some babies is often unclear. It's very unlikely to have been the result of anything you didor didn't do during pregnancy.

In a few cases, cleft lip and palate is associated with:

  • thegenes a child inherits from their parents (although most cases are a one-off)
  • smoking during pregnancy or drinking alcohol during pregnancy
  • obesity during pregnancy
  • a lack of folic acid during pregnancy
  • taking certain medicines in early pregnancy, such as some anti-seizure medications and steroid tablets

In some cases, a cleft lip or palate can occur as part of a condition that causes a wider range of birth defects, such as 22q11 deletion syndrome (sometimes known as DiGeorge or velocardiofacial syndrome) and Pierre Robin sequence .

Diagnosing cleft lip and palate

Cleft lips are usually picked up during the mid-pregnancy anomaly scan carried out when you're between 18 and 21 weeks pregnant. Not all cleft lips will be obvious on this scan and it's very difficult to detect a cleft palate on a routine ultrasound scan.

If a cleft lip or palate doesn't show up on the scan, it's normally picked up immediately after birth or during the newborn physical examination done within 72 hours of giving birth.

When a cleft lip or palate is diagnosed, you'll be referred to a specialist NHS cleft team who will explain your child's condition,discuss the treatments they may need and answer any questions you have.

You may also find it useful to contact a support group, such as the Cleft Lip and Palate Association , who can offer advice and put you in touch with parents in a similar situation.

Treatments for cleft lip and palate

Cleft lips and cleft palates are treated at specialist NHS cleft centres.

Your child will usually have a long-term care plan that outlines the treatments and assessments they're likely to need as they grow up.

The main treatments are:

  • surgery surgery to correct a cleft lip is usually carried out at 3-6 months and an operation to repair a cleft palate is usually performed at 6-12 months
  • feeding support you may need advice about positioning your baby on your breast to help them feed, or you mightneed to feed them using a specially-designed bottle
  • monitoring hearing babies born with cleft palates have a higher chance of glue ear, which may affect hearing; close monitoring of their hearing is important and if glue ear affects their hearing significantly, a hearing aid may be fitted or small tubes called grommets may be placed in their ears to drain the fluid
  • speech and language therapy if your baby is born with a cleft affecting their palate (cleft palate or cleft lip and palate) a speech and language therapist will monitor your child's speech and language development throughout their childhood; they will help with any speech and language problems as necessary
  • good dental hygiene and orthodontic treatment you'll be given advice about looking afteryour child's teeth , and braces may be needed if their adult teeth don't come through properly

Readmore about how cleft lip and palate is treated .

Outlook for cleft lip and palate

Themajority of children treated for cleft lip or palate grow up to have completely normal lives.

Most affected children won't have any other serious medical problems andtreatment can normally improve the appearance of the face and resolve issues such asfeeding and speech problems.

Surgery to repair the cleft mayleave a small pink scar above the lips. This will fade over timeand become less noticeable as your child gets older.

Some adults who've had a cleft lip or palate repair may be self-conscious or unhappy about their appearance. Your GP may refer you back to an NHS cleft centre for further treatment and supportif there are any ongoing issues.

Will a cleft lip and palatehappen again?

Most cleft lips and palates are a one-off and it's unlikely you'll have another child with the condition.

The risk of having a child with acleft lip or palate is slightly increased if you've had a child with the condition before, but the chances of this happening are thought to be around 2-8%.

If either you or your partner were born with a cleft, your chance of having a baby with a cleft is also around 2-8%. Most children of parents who had a cleft will not be born with a cleft.

The chances of another child being born with a cleft or of a parent passing the condition to their child can be higher in cases related to genetic conditions.

For example, a parent with 22q11 deletion syndrome (DiGeorge syndrome) has a 50% chance of passing the condition to their child.

Content supplied by the NHS Website

Medically Reviewed by a doctor on 13 Oct 2016