Handling children with a cleft lip or palate

Cleft lip and palate are conditions that are present at birth as a result of congenital malformation of the face that affects the lip and the palate (the roof of the mouth).

These types of malformation take place during the early stages of pregnancy, usually at around 7th week, when the foetus is quite small. Among blacks, cleft lip and palate affect about one child out of 1,000 live births.

A child may be born with cleft lip alone, cleft palate alone, or both cleft lip and palate. The cleft can be unilateral, affecting only one side of the lip, or bilateral, affecting both sides of the lip. The severity of the condition varies, but cleft lip and palate occurring together is usually more severe.

Various genetic and environmental factors contribute to the occurrence of the condition, although most cases are found in places where poverty is prevalent, and are most likely due to poor nutrition. Although children born with cleft lips experience other inconveniences such as feeding problems, poor speech development, ear infections and other psychological issues, the condition is usually not fatal. It can be easily corrected through surgery, which helps a child to live a normal life.

Dear Doc,

I am a mother of five and two of my children were born with cleft. Neither I nor my children’s father has a history of cleft in the family. What could have caused the condition?

Doris

CAUSES NOT YET KNOWN

Dear Doris,

The exact causes of cleft lip and palate are not yet known. However, certain factors have been associated with the occurrence of the condition. One factor known to increase the risk of the condition is genetics; in cases where one of the parents, siblings, or a relative has had the condition, a newborn is likely to develop the condition as well.

In most cases, the cleft is exactly like that of the mother or father. Because this seems not to be the case with your children, other factors might have been involved.

These include nutritional deficiencies of vitamins such as folic acid, which helps prevent major birth defects, use of certain medication such as anticonvulsants by the mother during pregnancy, which interfere with the metabolism of folic acid, and viral infections during pregnancy.

Observations in places where atomic bombing occurred indicate that exposure to radiation can also cause cleft in newborns.

Dear Doc,

Can cleft lip be detected during pregnancy and is there anything that can be done at this stage?

Eunice.

Dear Eunice,

Yes, it is possible to know whether your child will be born with cleft lip when you are pregnant. An ultrasound test is used to make images of the developing foetus. During the analysis of these images, the doctor can detect any abnormalities in the facial structure of the foetus.

Currently, treatment can only start once the child has been born and healthy enough to undergo surgery although studies are ongoing to see the added benefits of conducting in utero surgery for cleft lip and palate.

DIFFICULT BREASTFEEDING

Dear Doc,

My child was born with cleft palate and I am finding it difficult to breastfeed him. Please advise on what to do because I want my child to be healthy.
Worried Mum

Dear worried mum,

It is understandable what you are going through because it is every mother’s wish to bring up a healthy child. Breastfeeding a child with cleft can poses a big challenge because suckling requires a vacuum for the milk to flow properly.

Poor suckling means your child is not getting enough and this can result in retarded growth. Therefore, you can express breast milk and feed the child using a special feeding bottle with soft, long teat with a large hole and ensure the baby is well positioned while breastfeeding.

Ensure that the bottle and teat are always cleaned and sterilized often. Observe how the child feeds and know when to burp them. In addition, have the child’s weight monitored by a doctor or pediatrician so that you can know if the child is growing well.

Dear Doc,

My younger sister was born with cleft lip and palate. As a family, we would like to know what the treatment involves and what to expect.

Boris

OPTIMUM RESULTS

Dear Boris,

Treatment of cleft involves a multidisciplinary approach which consists of cleft surgeons, anesthesiologists, psychologists, speech therapists, dentists, orthodontists, paediatricians and ear nose and throat (ENT) specialists. Several surgeries are required to achieve optimum results.

The objectives of surgery are to improve facial appearance and ensure that the child is able to feed, speak, hear, and grow teeth normally.

The first surgery is usually done as soon as the child is healthy enough to withstand an operation. However, this might depend on the child and the health facilities and staff available.

The second surgery for cleft palate is very essential for speech development and is done before the age of 18 months to ensure that the palate is in proper condition by the time the child starts to develop speech.

It is at this stage that a speech therapist comes in handy. The third surgery involves alveolar bone graft, and it is done at the age of seven years to fill the cleft with bone so that the teeth can grow.

An orthodontist is needed at this stage to align the teeth. At the age of 16, jaw development and alignment is checked. If the jaws are not well aligned, orthognathic surgery is done to align them. Nose alignment is also done.

The success of the surgery largely depends on the competence of the surgeons, although revisions can be done later in cases of improper surgeries.

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