Mouth/palate Screening for defects-Infant

Mouth/palate Screening for defects-Infant

Mouth/palate Screening for defects

Summary of Recommendation and Evidence

Population

Recommendation

Grade
(What's This?)

Screening of both Genders

This screening is recommended a best practice.

B

Cleft lip and cleft palate may occur together or separately in a newborn child. Most cleft problems can either be found at the routine 20 - 24 week ultrasound examination, or at birth. A cleft lip affects a baby's and child's appearance, and a cleft palate can lead to feeding problems, speech and hearing problems, ear infections, dental decay, jaw development problems and psychosocial issues.

Prevalence

Cleft lip or palate appears in about 1 in 700 Caucasian babies, more often among Asians and certain groups of Native Americans, and less frequently among African-Americans. 

Caring for a baby with a cleft lip and/or palate

A family will usually be referred to an expert team very soon after the child's birth (or maybe earlier). The team will usually include a plastic surgeon, dental surgeon, ear, nose and throat surgeon, speech therapist and nutritionist.

If a baby with a cleft lip and/or palate is not feeding well, or is having ear infections, these could well be due to the birth defect. However, it is important to remember that difficulties in caring for a new baby may not all be due to a birth defect such as cleft palate. For example, many young babies cry a lot during the first few weeks of their life, and do not sleep well.

Symptoms

The cleft can be mild (a notch on the upper lip) or severe (involving the lip, the floor of the nostril, and the dental arch). A child with a cleft palate usually needs a speech pathologist. Language development can be affected not only by the structure of the lip and palate but also by the side effects of middle-ear infections, which are common in babies and toddlers with this defect (probably because their ears don't drain properly).

Babies with a cleft palate may also need help with feeding. (Those with a cleft lip generally don't have problems in this area.) Because they have trouble sucking, they must be fed in a sitting position with a special bottle. Depending on the severity of the condition, mothers who breastfeed may have to express milk and bottlefeed baby until the cleft is repaired.

How does a cleft lip or palate happen?

  • In the very early weeks of a baby's development, the two sides of the mouth are separate. At about 6 weeks after conception, the sides start to join together, beginning with the palate (the roof of the mouth), then forward to the upper lip and backwards to the soft palate.
  • In about 1 baby in 1000, the sides of the lip do not completely join together, leaving a gap, called a 'cleft'. Cleft palate occurs in about 1 in 2,500 babies. Overall about 1 in 800 babies will be affected by a cleft lip and/or a cleft palate. 
  • A cleft lip can occur on one side or both sides, and can vary from a small dent in the edge of the lip to a wide gap than goes up into the opening of the nose.
  • A cleft palate means that there is a hole in the roof of the mouth making a connection between the mouth and the nose (nasal cavity).

Why does a cleft lip or palate happen?

A cleft lip or cleft palate cannot be prevented. Research has shown that what parents do during pregnancy has no effect on whether a child will be born with these conditions. 

Babies are a little more likely to have a cleft if another person in the family (such as a parent or brother or sister) has a cleft, but the risk is still small (somewhere between 2 and 8%).

What problems can a cleft lip or palate cause?

  • Babies with a cleft palate will have difficulty feeding because they will not be able to form a seal around a nipple or teat which means they cannot suck strongly from the breast or a teat.
  • There are many ways that these babies can be helped to feed, including the use of special teats and bottles, and sometimes a small plastic plate to cover the cleft in the mouth.
  • It may be necessary to express breastmilk and give it by a bottle.
  • Feeding may be slow, and sometimes the babies do not gain weight as quickly as desired.
  • It is important to get specialist help if there are problems feeding a baby with a cleft palate. Referrals to the local Cleft Palate Unit will usually be made as soon as a baby is born (or earlier if the problem is detected before birth). Members of the unit will be able to help with feeding problems.
  • Babies with a cleft lip but not a cleft palate will usually not have feeding problems due to the cleft lip. They can breastfeed, but the mother may need to block the cleft with her thumb or breast tissue to enable the baby to get a good seal on the breast.
  • Children with cleft palates are likely to have more ear infections than other babies, and these can affect their hearing.
  • Some children with a cleft palate have difficulty with speech, though this is usually improved when the cleft is closed. Some children will need ongoing speech therapy.
  • Often a child's teeth will not develop normally in the area of the cleft, and the child will need orthodontic and other dental treatment.
  • A cleft lip affects the appearance of a child, and even when well repaired, there will be a small scar, which can affect how the child sees himself. The scar may be able to be improved when the child is a teenager. The topic Self-esteem has a link to a topic developed for Parenting SA for ideas which may help support a child who is unhappy about his appearance.

Treatment of the clefts

Surgery is done to repair the clefts. The exact timing of the surgery will depend on the specific nature of the defects that the baby has, and the health of the baby, but generally:

  • A cleft lip may be operated on when the baby is 2 to 3 months old.
  • The first operation on a cleft palate may be done between 9 and 18 months. The child may need several operations to fully repair a cleft palate, depending on how big the cleft is.