Treating cleft lip and cleft palate

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.

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