Cleft lip and cleft palate

Cleft lip and cleft palate are deformities of the lip, nose, and the roof of the mouth which may occur in about one in a thousand newborn babies. In these babies the upper lip is split and this split may continue into the nostril and right along the palate which is the roof of the mouth. One side of the lip and nostril or both sides may be affected. To see such a deformed face in a newborn baby would be deeply distressing, and very often a severe shock to the mother who has awaited the new arrival with joy and great expectations. Nevertheless, there is no need for despair. With careful treatment a baby with cleft lip and palate could be made to look near normal and also eat, drink and speak normally. For successful treatment parental cooperation and participation is essential. They must be motivated to get rid of the sorrow and play their role with courage.

Management
Most of these babies cannot suck milk in to their mouth because of the cleft in the palate. But if milk is introduced into the mouth they can swallow it with a little difficulty. There will be leakage into the nose, but this does not cause problems. Milk could be introduced into the mouth by one of several methods. At the beginning a spoon or a pipette could be used to place small quantities of milk on the side of the tongue. Gradually the baby could be trained to drink out of a bottle which should be either compressible (a plastic bottle) or if it is glass it must have a rubber balloon attachment which could be compressed so that milk is propelled into the mouth. As breast milk is best, expressed breast milk should be given to the baby in the way described above.

With patience, mothers learn to feed the baby adequately, and if this is carefully done there will be no problems about feeding. These babies have to undergo two or three operations before they are two years old. It is important to maintain a good nutritional status for them to be fit for these operations. The baby with the cleft lip and palate must be carefully looked after at home. They are more liable to get throat and ear infections. During cold days they should not be bathed, taken out or exposed to cold weather. Ideally only one person, preferably the mother, must handle the baby. Visitors must not be allowed to touch and fondle the infant. They may carry germs, which cause infections in the baby. If ear or throat infections occur treatment must be obtained as early as possible. These infections could weaken the general condition and also may cause complications later when the child undergoes operations.

The baby must be seen by a surgeon who could undertake surgical repair of the cleft lip and palate. This must be done very early so that the surgeon could plan the treatment. Timing of the operations depends on the type and severity of the cleft. Sometimes the surgeon may decide on certain non surgical treatment procedures before the operation. These may include the construction of a simple appliance, which the baby has to wear in the mouth. There is no discomfort and the baby usually learns to tolerate it. These appliances help to make the cleft narrow and thereby make the operation easier. There are several other doctors who could ensure that the baby gets the best treatment. The surgeon may want a family physician or a child specialist to see these babies. These doctors will see whether the babies are growing normally and whether they are fit for the surgery. They will also check  whether the baby has other illnesses and abnormalities. Sometimes abnormalities in the heart, spine, brain and other organs may be present in infants with cleft lip and palate. These, if present, must be treated as soon as possible.