Treating cleft lip and cleft palate

By Sara Curtis on November 12, 2012
First, the alarming news: cleft lip and palate (CLP) occur in one in 700 births in North America, making them among the most common major birth defects. But there is also good news: both are entirely treatable. With surgery and pre- and post-op care, most children born with CLP go on to live completely healthy, normal lives, with barely a scar to remind them of their early days.

A cleft is a fissure, or gap. A cleft lip is a split in the upper lip, between the mouth and the nose. The cleft can be unilateral (on one side only) or bilateral (on both sides).

A cleft palate occurs when the roof of a child’s mouth has not fused completely; cleft palates can also be unilateral or bilateral, and vary in size and severity. Cleft lip and palate can occur independently or together. These birth defects occur during the first trimester of pregnancy.

What causes CLP?

The reasons aren’t totally clear; some studies have found increased risk among expectant mothers who:
  • smoke or drink alcohol
  • are older 
  • have a family history of clefts (on either side of the family). But much of the time, the causes are unknown.
If your baby is born with a cleft lip or palate, there will be an examination immediately after birth by a pediatrician or midwife, who may recommend X-rays, bloodwork or ultrasounds to see how the other organs are functioning. They will also try to determine whether your baby is among the five to eight percent of children with CLP who also have a larger genetic disorder.

Future treatments

You will then likely be referred to a team of specialists who deal with CLP, including an ear, nose and throat doctor, a speech and language pathologist, and an audiologist. Babies with CLP can have feeding difficulties, and often need to drink from specially adapted bottles. Other common problems include recurrent ear infections, dental abnormalities and speech difficulties.

If your baby has a cleft lip, he will have surgery to repair it when he is around three months old. If he has a cleft palate, the surgery is performed between nine and 12 months of age. In some cases, subsequent surgeries are required for kids with cleft palate, to deal with speech or dental issues.

With proper treatment, coupled with a supportive home environment, Canadian kids born with CLP will grow up just like any other child.

Facing the future with dignity

  • Babies born with CLP need immediate treatment and care – and, depending on where they live, that doesn’t always happen. “In Canada we are very fortunate,” says Estaban Lasso, executive director of Transforming Faces, a Canadian charity that promotes access to CLP care to kids and adults in developing countries. “When a child with CLP is born in Canada, they see a specialist team in less than 48 hours. There are 30 CLP specialists at Sick- Kids Hospital in Toronto alone. But in developing countries, the parents are often shocked and they feel guilty and isolated. Sadly, this can lead to infanticide, especially in countries like China and India.”
  • CLP is more common in Latin and East Asian populations. In some developing countries, the frequency is as high as one in 500.
  • Transforming Faces’ mission is to “close the gap in CLP care” around the world. They provide surgical treatment and follow-up care to the kids and their families. “Some kids require speech therapy for many years. So their needs don’t just end with the surgery,” says Estaban.
  • Since it was established in 1999, the charity has helped more than 10,000 kids from seven different countries: Peru, Argentina, Ethiopia, Ghana, China, India and Thailand.
  • “We put a lot of value on training people from those countries – establishing medical teams that can provide ongoing care. Transforming Faces is about more than surgery. It’s about transforming lives,” says Estaban.

Originally published in ParentsCanada magazine, November 2012.

By Sara Curtis| November 12, 2012

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