Cleft lip and palate

The commonest craniofacial condition in the UK. Surgery is early; speech, hearing and dental care run for two decades.

What it is

Around 1 in 700 babies in the UK is born with a cleft lip, a cleft palate, or both. It happens when the tissues forming the lip or roof of the mouth do not join completely in early pregnancy.

Surgical repair happens early: lip usually around three months, palate around six to twelve months. Which is why people assume it is dealt with in infancy.

It is not. The pathway runs for around twenty years: speech and language therapy, hearing checks because glue ear is very common, orthodontics, further surgery in some cases, and psychological support around appearance.

Care in the UK is delivered by regional cleft teams, and outcomes improved markedly when services were centralised.

Signs you might notice

Visible at birth for a cleft lip. A cleft palate may be less obvious and is checked at the newborn examination.

Feeding difficulty in the newborn period, because a cleft palate prevents effective suction.

Later: speech that sounds nasal, or difficulty with certain sounds.

Recurrent glue ear and fluctuating hearing loss.

Dental problems: missing, extra or misaligned teeth.

Submucous cleft palate can be hidden and present later as nasal speech, and it is easily missed.

How it can affect day-to-day life

Feeding is the first crisis, and it is solvable with specialist bottles and support from a cleft nurse specialist. Families should not be left struggling.

Hearing is the piece most often under-managed, and it matters because speech development depends on it.

The psychological side runs long: appearance-related distress in adolescence is common and normal, and specialist psychology is part of the cleft team for that reason.

Speech outcomes depend on therapy access, and provision varies.

Supporting someone well

Get the cleft nurse specialist involved for feeding immediately. Specialist bottles make the difference.

Keep every hearing appointment. Fluctuating hearing loss during the speech-learning years causes lasting difficulty.

Attend speech and language therapy consistently, and do the home practice; it is what makes the difference.

Keep up dental and orthodontic care, which is long and unglamorous and determines the adult result.

Use the team's psychologist without waiting for a crisis, particularly around secondary school.

Talk about it openly with the child. Children who can explain their own cleft handle questions far better.

Where to get help

Care is through a regional NHS cleft team; every family should have one and a named nurse specialist.

CLAPA, the Cleft Lip and Palate Association, provide feeding equipment, peer support and excellent information.

Nasal-sounding speech in a child with no known cleft warrants assessment for a submucous cleft.