Cleft lip and cleft palate are openings or gaps in the upper lip and the roof of the mouth that form during the early weeks of pregnancy when tissues that should grow together don’t fully join. These conditions affect how a baby’s face develops and can range from a small notch in the lip to a large opening that extends into the nose, or a split in the palate that runs all the way from the front to the back of the mouth.

Understanding Cleft Lip and Palate

When a baby is developing in the womb, the face forms as different parts gradually move together and fuse. Between the fourth and seventh week of pregnancy, tissues from each side of the head join together at the center of the face to create the lips and mouth. The roof of the mouth, called the palate, forms a bit later, between the sixth and eleventh week of pregnancy. If some of these tissues fail to join completely before birth, the result is a cleft.

A cleft can affect only the lip, only the palate, or both structures together. When the cleft involves just the lip, it may appear as a small notch in the colored part of the upper lip or as a complete separation that reaches all the way up into the nose. This opening can occur on one side of the mouth, which doctors call a unilateral cleft, or on both sides, known as a bilateral cleft. Sometimes the cleft also affects the gum where teeth will eventually come through.

A cleft palate creates a gap in the roof of the mouth. The back portion of the palate, toward the throat, is called the soft palate because it contains muscle and soft tissue. The front portion is the hard palate, which has bone underneath. A cleft can affect just the soft palate, or it can extend through both the soft and hard palate. Some cleft palates are hidden beneath the lining of the roof of the mouth and may not be noticed right away after birth.

Because the lip and palate develop at different times during pregnancy, it’s entirely possible for a baby to have one without the other. However, when both occur together, it’s the most common combination. A cleft lip with cleft palate happens more frequently than having just one or the other alone.

How Common Are These Conditions

Cleft lip and cleft palate are among the most common birth defects that babies can be born with. Around one in every 700 babies worldwide is born with a cleft somewhere on their face. In the United States, approximately one in every 1,050 babies is born with cleft lip with or without cleft palate, while about one in every 1,600 babies is born with cleft palate alone.

Cleft lip, either with or without a cleft palate, occurs more often in boys than in girls. On the other hand, cleft palate by itself is more common in girls. The occurrence of clefts also varies among different populations. Studies show that clefts appear more frequently in people of Asian descent, with rates around one in every 500 births. People of European descent have an average rate of about one in 700 births, while those of African descent have the lowest rate at approximately one in 1,200 births.

Left-sided cleft lip is more common than right-sided cleft lip, and clefts that affect only one side of the mouth are seen more often than those affecting both sides. Around 45 percent of babies born with a cleft have only a cleft palate, 24 percent have only a cleft lip, and 31 percent have both a cleft lip and palate together. Bilateral cleft lip and palate is the least common type, occurring in just 9 percent of cases.

What Causes Cleft Lip and Palate

In most cases, doctors cannot pinpoint exactly what caused a baby to be born with a cleft. Parents often worry they did something wrong during pregnancy, but the truth is that clefts are rarely caused by anything a mother did or didn’t do. Most experts believe that a combination of genetic and environmental factors working together causes these conditions, though the exact mix remains unclear in the majority of births.

Genetics plays a role in some cases. If a parent, sibling, or other close family member was born with a cleft, the chance of having a baby with a cleft increases. Scientists have discovered that gene defects inherited from one or both parents can prevent the lip and mouth from joining properly during development in the womb. However, many babies born with clefts have no family history of the condition at all, which doctors refer to as a “one-off” occurrence.

About 30 percent of babies with clefts have them as part of a larger genetic syndrome. A syndrome is a collection of symptoms and health problems that occur together because they share the same underlying cause, often genetic. Cleft lip or palate appears in more than 400 different syndromes, including conditions such as Down syndrome, Waardenburg syndrome, and Pierre Robin sequence. When a cleft is part of a syndrome, the baby may have other health challenges beyond the cleft itself.

Environmental factors during early pregnancy can also contribute to the risk. These factors include things that happen outside the body or behaviors that affect the developing baby. Research has shown that certain situations may increase the likelihood of a cleft, though they don’t guarantee one will occur.

Risk Factors That May Increase the Chance of Cleft

Several factors related to the mother’s health and environment during pregnancy have been linked to a higher risk of having a baby with a cleft. Smoking during pregnancy is one of the most consistently identified risk factors. When a mother smokes cigarettes while pregnant, it increases the chance that her baby will develop a cleft lip or palate. Similarly, drinking alcohol during pregnancy has been associated with a higher risk of clefts.

A mother’s nutritional status matters as well. A lack of folic acid, also known as Vitamin B, during the early weeks of pregnancy when the face is forming may increase the risk of cleft. Folic acid is a nutrient found in leafy green vegetables, citrus fruits, beans, and fortified grain products, and it’s also available as a supplement. Doctors often recommend that women take folic acid before they become pregnant and during early pregnancy to support proper development.

Certain medications taken during pregnancy have been linked to clefts. Anti-seizure medications used to control epilepsy may increase the risk, as can some acne treatments containing a drug called isotretinoin (also known by the brand name Accutane). Another medication called methotrexate, which treats cancer, arthritis, and psoriasis, has also been associated with a higher risk of cleft. Women who take these medications should talk with their doctors about the risks and benefits during pregnancy.

A mother’s weight and age may play a role as well. Women with obesity during pregnancy and those who are either teenagers or over 35 years old appear to have a slightly higher risk of having a baby with a cleft. Exposure to certain viruses, infections, chemicals, or other environmental agents that can disrupt normal fetal development may also contribute, though the specific substances vary.

Symptoms and Challenges Children Face

The most obvious symptom of a cleft lip or palate is the visible gap itself. A cleft lip can usually be seen immediately at birth or may be detected during a prenatal ultrasound before the baby is born. The opening may be small, appearing as just a notch in the upper lip, or it can be large, creating a wide separation that extends up into one or both nostrils. A cleft palate may be visible when looking inside the baby’s mouth, or it may be hidden beneath the surface lining of the palate, making it harder to detect.

Beyond the visible difference, babies with cleft lip and palate face several functional challenges, especially in the early months of life before surgery can be performed. Feeding is often the first and most pressing difficulty. A baby with a cleft palate cannot create the suction needed to breastfeed or drink from a regular bottle effectively. The gap in the roof of the mouth prevents them from forming a seal, which means air can enter through the nose while feeding, and milk may come back out through the nose rather than going down to the stomach. This makes feeding frustrating and tiring for both baby and parent, and the baby may struggle to gain weight properly.

Hearing problems are another common challenge. Babies with cleft palate are more vulnerable to ear infections and a condition called glue ear, where thick fluid builds up in the middle ear behind the eardrum. This happens because the muscles that open and close the tube connecting the middle ear to the throat don’t work properly when there’s a cleft palate. The fluid buildup can reduce hearing, which in turn may affect how well a child learns to speak and understand language as they grow.

Dental problems often develop in children with clefts that involve the gum area. Teeth may be missing, extra teeth may grow in, or teeth may come in tilted or out of position near the cleft. Children with clefts have a higher risk of tooth decay and may need special dental care throughout childhood and into their teenage years.

As children grow older, speech difficulties may emerge if the cleft palate hasn’t been repaired properly or early enough. The palate plays a crucial role in speech because it separates the mouth from the nose, allowing certain sounds to be made correctly. Without a properly functioning palate, speech may sound nasal, or the child may have trouble producing certain consonant sounds clearly. Some children also experience problems with their breathing, particularly if they have a small lower jaw along with the cleft, a combination seen in Pierre Robin sequence.

Many of these challenges can be addressed with proper treatment. Surgery, special feeding techniques, hearing aids or ear tubes, dental care, and speech therapy can all help children with clefts develop and grow just like any other child. With comprehensive care from a team of specialists, most children born with cleft lip or palate lead healthy, normal lives.

How Clefts Are Diagnosed

Many cleft lips can be detected before birth during routine prenatal care. A cleft lip may show up on an ultrasound scan, which uses sound waves to create images of the developing baby. Healthcare providers can often spot a cleft lip starting around the 13th week of pregnancy, and it becomes easier to see as the pregnancy progresses. More advanced ultrasound techniques that create three-dimensional images can detect clefts even earlier in some cases.

Cleft palate is much harder to see on an ultrasound before birth because the roof of the mouth is difficult to visualize in these images. Most cleft palates are not discovered until after the baby is born. If a cleft lip or palate is not seen on prenatal scans, it’s usually diagnosed immediately after birth when the baby is first examined, or during the newborn physical examination that happens within the first 72 hours of life.

When a cleft is diagnosed, either before or after birth, parents are typically referred to a specialized cleft team. This team consists of various healthcare professionals who work together to plan and coordinate the child’s care from infancy through young adulthood. The team may include surgeons, nurses, speech therapists, dentists, orthodontists, ear, nose and throat doctors, audiologists who test hearing, feeding specialists, and sometimes psychologists or social workers who provide emotional support.

In some cases, genetic testing and counseling may be recommended. If doctors suspect that the cleft is part of a larger syndrome, they may suggest tests to identify the underlying genetic cause. This information can help the family understand what other health issues might occur and what the chances are of future children being born with a cleft or related conditions. A procedure called amniocentesis, which takes a sample of the fluid surrounding the baby in the womb, may be offered during pregnancy if a syndrome is suspected based on the ultrasound findings.

Prevention Strategies

Because the exact cause of most clefts remains unknown, there is no guaranteed way to prevent them. However, there are several steps that women can take before and during pregnancy to reduce the risk. These measures support healthy fetal development during the critical early weeks when the face is forming.

Taking folic acid supplements is one of the most important preventive measures. Women who are planning to become pregnant should begin taking 400 micrograms of folic acid daily at least one month before conception and continue through the first trimester of pregnancy. Some doctors recommend continuing folic acid throughout the entire pregnancy. This B vitamin plays a crucial role in cell growth and development, and adequate levels during early pregnancy may lower the risk of clefts and other birth defects.

Avoiding smoking and alcohol during pregnancy is essential. Women should stop smoking and drinking alcohol as soon as they learn they are pregnant, or ideally, before trying to conceive. Both substances can interfere with normal fetal development and have been clearly linked to an increased risk of cleft lip and palate. Even secondhand smoke exposure should be minimized.

Women who take prescription medications should discuss them with their doctor before becoming pregnant. Some medications, particularly certain anti-seizure drugs and acne treatments, carry a higher risk of causing birth defects including clefts. In many cases, doctors can adjust the medication or find safer alternatives during pregnancy, but these changes should only be made under medical supervision.

Maintaining a healthy weight before and during pregnancy may also help. Women with obesity have a slightly higher risk of having babies with birth defects, so achieving a healthy weight before conception is beneficial for many reasons. Eating a balanced diet rich in fruits, vegetables, and whole grains provides essential nutrients for fetal development.

Women should seek early prenatal care as soon as they suspect they are pregnant. Regular checkups allow doctors to monitor the pregnancy and address any health concerns promptly. Avoiding exposure to infections, chemicals, and environmental toxins whenever possible is also wise, though it’s not always easy to know which substances might be harmful.

How Cleft Lip and Palate Affect the Body

To understand how clefts affect a child’s body, it helps to know what the lip and palate normally do. The lips form a seal around the breast or bottle during feeding, creating the vacuum needed for a baby to draw milk into their mouth. The lips also play a role in speech later in life, particularly for sounds like “p,” “b,” and “m” where the lips must come together.

The palate serves several important functions. It separates the mouth from the nasal cavity above it, which is essential for both eating and speaking. During swallowing, the soft palate moves upward to close off the nose, preventing food and liquid from entering the nasal passages. For speech, the soft palate works like a valve, opening to allow air through the nose for nasal sounds like “n” and “m,” and closing to direct air through the mouth for other sounds.

When a cleft lip is present, the disruption to the circular muscle around the mouth affects the baby’s ability to create suction during feeding. The opening in the lip breaks the seal needed to draw liquid effectively. If the cleft extends into the gum, it can also affect how teeth develop and align in that area, because the bone underneath the gum may also be split.

A cleft palate creates more complex problems because it connects the mouth and nose in a way that shouldn’t exist. Liquids and food can easily pass up into the nasal cavity when swallowing, which is uncomfortable and can lead to choking or difficulty breathing during feeding. The opening also prevents the buildup of air pressure in the mouth that’s needed to produce certain speech sounds clearly. Children may sound as if they are speaking through their nose because air escapes upward through the cleft instead of coming out through the mouth.

The muscles in the soft palate normally open and close the Eustachian tube, which is the passage connecting the middle ear to the back of the throat. This tube allows air to enter the middle ear and fluid to drain out. When a cleft palate exists, these muscles don’t function properly, so fluid cannot drain from the middle ear as it should. The trapped fluid creates the perfect environment for bacterial growth, leading to frequent ear infections. Over time, thick fluid accumulates in the middle ear, causing glue ear, which muffles hearing like having water in your ears constantly.

The reduced hearing from glue ear during the critical years when children are learning language can slow down speech and language development. Children need to hear words clearly to learn how to say them correctly and to understand what they mean. If hearing is impaired during these formative years, it can affect how well they communicate and learn.

Over time, if a cleft palate is not repaired, the abnormal function can also affect the growth and development of the face and jaw. The bones of the face grow differently when the palate is split, sometimes leading to the upper jaw being smaller or set back compared to the lower jaw. This can cause bite problems and affect facial appearance.