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Cleft palate is a treatable
birth defect. It happens when the roof of the baby's mouth (palate) doesn't
develop normally during pregnancy, leaving an opening (cleft) in the palate
that may go through to the nasal cavity. A cleft can form on any part of the
palate, including the front part of the roof of the mouth (hard palate) or the
small flap of tissue that hangs down from the soft palate (uvula). It may appear by itself or along with other
birth defects of the face and skull, such as a
Cleft palate and cleft lip
are the most common birth defects of the head and neck. Until a cleft palate is treated with surgery, it can cause
problems with feeding, speech, and hearing.
Doctors aren't sure what
causes it. But your baby may be more likely to have cleft palate if you:
It's important to take good care of yourself before and
during your pregnancy so that your baby will be as healthy as possible.
If someone in your family was born with a cleft palate, you may want to think about
genetic counseling. It can help you understand your
chances of having a child with a cleft palate.
Some forms of cleft palate
are easy to see when the child is born. But even if the cleft palate doesn't affect
how the baby’s face looks, it can usually be seen inside the mouth.
The location of the cleft matters more than how it looks. A small cleft
in the soft palate may cause more problems—because of its effect on speech—than
a large cleft that is easy to see.
Babies with cleft palate often
have feeding problems because they aren't able to suck and swallow normally.
But this doesn't always last, especially with treatment.
A doctor can
diagnose cleft palate by doing a physical exam of the baby’s mouth shortly
Fetal ultrasound can sometimes find cleft palate as
early as 14 to 16 weeks into pregnancy, especially if the cleft palate is
severe and occurs along with a cleft lip. But ultrasound doesn't always find
the problem, so doctors don't rely on it to diagnose cleft palate.
Treatment involves a team of
health care providers. The type of treatment depends on how severe the problem
Surgery is the most common treatment for cleft palate. For the
most part, it’s done before a child is 12 months old.1 Before surgery, your baby may need treatment for breathing or feeding problems. He or she may also wear a mouth support, such as a dental splint, a soft dental molding
insert, or medical adhesive tape.
your child grows, he or she will probably need more than one operation. But the
problem is normally fixed by the time a child is a teen. Although
surgery often leaves scars, the palate usually heals well and leaves few signs
of the cleft. A child’s facial bones most often grow normally, and the child
speaks more clearly.
Some children who have cleft palate need more
treatment for other problems, such as speech, hearing, or teeth problems; sinus
and ear infections; and problems from surgery.
If your baby is born with a cleft palate, get help with feeding. A nurse
can guide you on feeding techniques. Watch for infections and hearing or
teeth problems too.
As your child with cleft palate grows, pay special
attention to dental care, hearing, and speech. You can also support your child's self-esteem. Explain how cleft palates form and how having one has been a part of making your child strong.
Caring for a child
with cleft palate can take a lot of time and patience. Seek support from
friends and family. You can join a support group to meet others who are going
through similar challenges.
Learning about cleft palate:
AboutFace is a nonprofit international organization that provides
information, support, and other resources to people who have facial differences. The website has information on cleft
palate, cleft lip, and other
The American Society of Plastic Surgeons (ASPS) is the
largest plastic surgery specialty organization in the world. This site has news
on the latest advances and techniques of specific surgical procedures. It
includes information on how to prepare for surgery, types of anesthesia used,
recovery time, and average costs. You can find a qualified surgeon in your
area, view before-and-after photographs, and read patient stories.
The Cleft Palate Foundation is a nonprofit organization that
has information for children, adults, and families affected by clefts and other craniofacial
birth defects. It was founded by the American Cleft Palate-Craniofacial Association, an
international nonprofit group of health professionals who are involved in treatment and/or research of craniofacial conditions.
The Web site has information about treatment, feeding, dental care, speech, hearing, and more. You can call the toll-free phone number to get medical information
and to find support groups.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care.
Heike CL, Cunningham ML (2011). Craniofacial disorders. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 705–713. New York: McGraw-Hill.
Other Works Consulted
American College of Obstetricians and Gynecologists
(2003, reaffirmed 2011). Neural tube defects. ACOG Practice Bulletin No. 44. Obstetrics and Gynecology, 102(1): 203–210.
Bessell A, et al. (2011). Feeding interventions for growth and development in infants with cleft lip. Cochrane Database of Systematic Reviews (2).
Edwards SP, et al. (2007). Cleft lip and palate. In DM
Laskin, AO Abubaker, eds., Oral and Maxillofacial Surgery, pp. 135–151. Chicago: Quintessence Publishing.
Hoffman WY (2012). Cleft lip and palate. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 345–361. New York: McGraw-Hill.
Kapp-Simon KA (2006). A brief overview of psychological issues in cleft lip and palate. In S Berkowitz, ed., Cleft Lip and Palate, 2nd ed., pp. 257–261. New York: Springer.
Klein U (2011). Oral medicine and dentistry. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 442–451. New York: McGraw-Hill.
Mossey PA, et al. (2009). Cleft lip and palate. Lancet, 374(9703): 1773–1785.
Porter RS, et al., eds. (2011). Congenital craniofacial and musculoskeletal abnormalities. In Merck Manual of Diagnosis and Therapy, 19th ed., pp. 2969–2975. Whitehouse Station, NJ: Merck Sharp and Dohme Corp.
Rowe LD (2009). Congenital disorders of the oral cavity and lip section of Congenital anomalies of the head and neck. In JB Snow Jr, PA Wackym, eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 17th ed., pp. 835–838. Hamilton, ON: BC Decker.
Shi M, et al. (2007). Orofacial cleft risk is increased with maternal smoking and specific detoxification-gene variants. American Journal of Human Genetics, 80(1): 76–90.
Wolfe SA, et al. (2006). Surgical treatment of clefts
of the lip and palate from birth to age ten. In S Berkowitz, ed.,
Cleft Lip and Palate: Diagnosis and Management, 2nd ed.,
chap. 22, pp. 459–475. Berlin: Springer.
January 19, 2012
John Pope, MD - Pediatrics & Adam David Schaffner, MD, FACS - Plastic Surgery, Otolaryngology
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