A "cleft" is a split or a divide. Cleft lips and palates happen before birth. A baby can have a cleft lip, cleft palate, or both. A cleft lip may be on one or both sides of the upper lip. The split may also be in the upper jaw and gum.
A cleft palate is an opening in the roof of the mouth. The front part is the bony hard palate. The back part is the soft palate, made of muscle. A cleft palate can be on one side or both sides of the mouth.
A child can have a submucous, or hidden, cleft palate. This happens when tissue, called the mucous membrane, covers the cleft. It is the pink tissue that you see in your mouth. The cleft may be hard to see, and you may not know it is there.
Cleft lip or palate is the most common birth defect in the United States. Clefts happen very early in pregnancy, and the cause is unknown. Some possible risk factors include:
Most of the time, a doctor will see a cleft lip or palate at birth. A cleft lip may show on an ultrasound before birth. It is harder to see a cleft palate on ultrasound.
It is not always easy to see a cleft palate. Your child may have a weak suck and take a long time to feed. Milk may come out of your child's nose. These are possible signs of a cleft.
A submucous cleft may cause feeding problems. Your child may have a bifid uvula, which is a sign of a cleft. Your uvula is the piece of tissue that hangs in the back of your throat. You can see it when you look into the back of your mouth. A bifid uvula has a split in it. If you see this, you should talk to your doctor about a possible cleft palate.
In other cases, this type of cleft may not show up until your child starts talking. His speech may sound hyper-nasal, or like the sound is coming out of his nose rather than the mouth. This may be a clue that there is a cleft palate.
You should have your child’s hearing tested if she has a cleft. Your child may have trouble with fluid in her ears and may get ear infections. This is more common in children with a cleft palate than with a cleft lip.
Your child will need services from a number of professionals. Many times, services come from a cleft palate or craniofacial team. This team may include a:
Your child will see this team for a few years. The surgeon will close your child’s cleft lip or palate. This usually happens before your child turns 1 year. The dentist and orthodontist help straighten your child's teeth and jaw. The SLP or nurse will look at how your child feeds. The SLP will watch how your child's speech and language develop. The SLP will also check feeding and swallowing. The audiologist will test your child's hearing. The team works together to do what is best for your child.
Find a team near you by visiting the American Cleft Palate-Craniofacial Association (ACPA) website.
Babies with a cleft lip will likely breastfeed or use a typical bottle. Babies with a cleft palate may have trouble breastfeeding. If they bottle-feed, they may need special bottles or nipples. You may work with the SLP or other team member to find the best bottle. The team will also watch your child's growth and nutrition.
Learn more about feeding and swallowing problems in children.
A child with a cleft lip may not have many speech problems. A child with a cleft palate may need to work with an SLP. They may need help learning to make sounds and speak clearly.
Some children have problems with their soft palate. The soft palate needs to move to touch the back of the throat. This closes the space between our mouth and nose. We need the soft palate to function appropriately because most sounds can come out of our mouth. Some sounds, like "m" and "n," come out of our nose. The soft palate needs to be able to fully open and close for sounds to "sound right." If the soft palate is unable to fully open and/or close sound may either be perceived as hypo-nasal (sounds like you have a cold or a stuffy nose) or hyper-nasal (sounds are pushed through the nose and have nasal-sounding quality)
A child with velopharyngeal insufficiency, or VPI, cannot touch his soft palate to the back of his throat. His soft palate is too short or does not move the right way. This lets air and sound escape through his nose when he talks. He may need surgery to fix VPI. He may need a device in his mouth to help close the soft palate. Your child may also need speech therapy. VPI may happen when a child has a cleft. It can also happen to children who do not have a cleft.
See ASHA information for professionals on the Practice Portal’s Cleft Lip and Palate page.