Cleft lip and palate are common birth conditions that affect how a child’s face and mouth develop before birth. While they create challenges in feeding, speech, and hearing, a well-coordinated care approach involving surgery, speech therapy, and specialized support can help children grow up healthy and lead normal lives.

Understanding Care Goals for Children with Cleft Conditions

When a baby is born with a cleft lip or palate, the main goal of treatment is to help the child function as normally as possible. This means ensuring they can eat properly, breathe without difficulty, speak clearly, and develop healthy teeth. The treatment also aims to improve the child’s appearance so that scarring is minimal and the face looks balanced and natural. These goals require careful planning and a step-by-step approach that continues from infancy through young adulthood.^[1][2]

Treatment depends heavily on the type of cleft a child has. A cleft lip is a gap in the upper lip that can range from a small notch to a large opening reaching the nose. A cleft palate is a split in the roof of the mouth. Some children are born with both conditions, while others have only one. The size and location of the cleft determine what kind of care is needed and when surgeries should happen.^[3][4]

Because clefts affect multiple areas of a child’s development, treatment is not just about surgery. Children need ongoing support from a team of specialists who work together to address feeding difficulties, hearing problems, dental issues, and speech delays. This team-based approach ensures that every aspect of the child’s health and development is monitored and supported over many years.^[5][6]

Medical societies recommend that all children with clefts receive care from specialized cleft teams or craniofacial teams. These teams include surgeons, nurses, speech therapists, orthodontists, ear specialists, feeding experts, psychologists, and other professionals who meet regularly to plan and coordinate care. This coordinated system helps families navigate the many appointments and treatments their child will need as they grow up.^[16][17]

Standard Treatments for Cleft Lip and Palate

The cornerstone of cleft treatment is surgery to close the gap in the lip or palate. Surgery is usually done in stages, starting when the baby is still very young. The timing of surgery is carefully chosen to balance the need for early repair with the child’s overall growth and development.^[10][11]

Cleft Lip Surgery

Surgery to repair a cleft lip typically happens when the baby is between three and six months old. During the operation, the surgeon rearranges the tissues around the cleft to close the opening. An important part of this surgery involves repositioning the muscles of the lip to recreate the circular muscle around the mouth, which is essential for normal lip function. The procedure usually takes one to two hours, and most babies stay in the hospital for one to two days.^[10][14]

After surgery, stitches are used to hold the tissues together. These stitches may dissolve on their own or need to be removed after a few days. The surgical scar will fade over time and is usually positioned to follow the natural lines of the lip, making it less noticeable as the child grows. Parents are often surprised at how quickly their baby recovers and how much the appearance improves after surgery.^[4][10]

Cleft Palate Surgery

Cleft palate repair is usually performed when the baby is between six and twelve months old, and ideally before eighteen months of age. The surgery is scheduled early to help prevent speech problems from developing. During the operation, the surgeon closes the gap in the roof of the mouth and rearranges the muscles and tissues of the palate. This creates a functional separation between the mouth and nose, which is essential for proper speech development.^[5][14]

The procedure takes about two hours and requires general anesthesia, meaning the child is fully asleep. Most children stay in the hospital for one to three days after palate surgery. The wound is closed with dissolvable stitches, and the scar remains inside the mouth where it is not visible. Recovery involves careful feeding and monitoring to ensure the surgical site heals properly.^[10][13]

Additional Surgical Procedures

Many children with cleft lip or palate will need more than one surgery as they grow. Around eight to twelve years of age, when permanent teeth are coming in, a bone graft may be needed to fill in any gap in the gum area. This procedure involves taking a small piece of bone, often from the hip, and placing it in the cleft area to support tooth development and provide stability to the upper jaw.^[10][11]

During the teenage years, some children may benefit from surgery to improve the shape of the nose, called rhinoplasty. Others may need surgery on the jaw to correct growth differences between the upper and lower jaw. These procedures help improve both appearance and function, especially if earlier surgeries did not heal perfectly or if growth has created new problems.^[11][15]

Feeding Support

Babies with cleft palate often struggle with feeding because they cannot create a good seal with their mouth. This makes breastfeeding difficult or impossible, and they may take in too much air or have milk come out through their nose. Specialized feeding bottles designed for babies with clefts can help. These bottles are more flexible and have special nipples that make it easier for babies to get enough milk without needing to create suction.^[4][18]

A feeding specialist or speech therapist can teach parents techniques for positioning the baby and using special bottles effectively. Some mothers choose to pump breast milk and feed it through these special bottles, which allows the baby to receive the benefits of breast milk even if direct breastfeeding is not possible. In rare cases, a baby may need to be fed through a tube placed into the nose until surgery can be performed.^[10][18]

Hearing Care

Children with cleft palate are more likely to develop ear infections and a condition called glue ear, where fluid builds up in the middle ear. This fluid can affect hearing, which in turn can delay speech and language development. Regular hearing tests are essential to catch these problems early.^[4][10]

If glue ear is affecting a child’s hearing, small tubes called grommets may be placed in the eardrums to help drain the fluid. In some cases, hearing aids may be recommended. Hearing problems often improve after the palate is repaired, but ongoing monitoring is important throughout childhood.^[4][10]

Speech and Language Therapy

Most children born with cleft palate will need speech therapy at some point in their lives. Even after the palate is repaired, some children develop speech patterns that sound nasal or have difficulty pronouncing certain sounds. A speech-language pathologist monitors the child’s speech development starting from infancy and provides therapy when needed.^[6][14]

Speech assessments typically happen at eighteen months, three years, and five years of age to check if the child’s speech is developing normally. Therapy may involve exercises to strengthen the muscles of the mouth and palate, practice with specific sounds, and techniques to reduce nasal-sounding speech. Most children with cleft palate can develop clear, understandable speech with appropriate therapy and support.^[10][14]

Dental and Orthodontic Care

Children with clefts often have dental problems, including missing teeth, extra teeth, or teeth that are tilted or out of position. A pediatric dentist monitors the health of the child’s teeth from an early age and recommends treatments as needed. It is also important for families to register their child with a regular dentist for routine care.^[10][13]

Orthodontic treatment, which uses braces or other devices to straighten teeth and improve alignment, is often needed. This treatment may start during the mixed dentition period, when the child has both baby teeth and permanent teeth, usually around six to eight years of age. Orthodontic appliances can also be used to expand the upper jaw if it is too narrow, which is common after palate surgery.^[15][16]

The goal of dental and orthodontic care is not only to improve appearance but also to ensure that the child can bite and chew properly. In some cases, orthognathic surgery, which repositions the jaw, may be needed in the teenage years if there is a significant mismatch between the upper and lower jaw.^[15]

Possible Side Effects and Complications

Like any surgery, cleft repair carries risks including bleeding, infection, and problems with anesthesia. After surgery, there is a small chance that the surgical site may not heal properly, which could require additional surgery. Some children develop small holes, called fistulae, between the mouth and nose after palate repair. These can usually be repaired in a later surgery.^[11]

Early palate repair is associated with better speech outcomes, but it may also affect facial growth. Some children develop a smaller or “set-back” upper jaw, which can affect their bite and appearance. This is why the timing of surgery is carefully considered by the cleft team, balancing the need for good speech with the desire for normal facial growth.^[15]

Innovative Approaches Being Tested in Clinical Trials

While the sources provided do not contain specific information about experimental drugs or clinical trials for cleft lip and palate treatment, the field is actively exploring new surgical techniques, better timing strategies, and improved methods for predicting which children will need additional surgeries. Research is ongoing to better understand how to optimize both functional outcomes and facial growth, and to develop less invasive approaches to care. Families interested in participating in research studies should discuss this option with their cleft team, as some specialized centers are involved in clinical research aimed at improving treatment outcomes.^[11][16]

Most Common Treatment Methods

• Surgical Repair
  • Cleft lip surgery at three to six months to close the gap in the lip and reposition muscles
  • Cleft palate surgery at six to twelve months to close the gap in the roof of the mouth
  • Bone grafting at eight to twelve years to fill gaps in the gum and support tooth development
  • Revision surgeries to improve lip or palate appearance and function if needed
  • Rhinoplasty in teenage years to improve nose shape
  • Jaw surgery if growth differences between upper and lower jaw require correction
• Feeding Support
  • Specialized bottles with flexible designs for babies who cannot breastfeed directly
  • Breast milk feeding through expressed milk and special bottles
  • Positioning techniques taught by feeding specialists to help babies eat efficiently
  • Tube feeding in rare cases where baby cannot take enough nutrition by mouth
• Hearing Care
  • Regular hearing tests to monitor for ear infections and fluid buildup
  • Grommet insertion to drain fluid from middle ear if glue ear develops
  • Hearing aids if hearing loss affects speech development
• Speech and Language Therapy
  • Regular speech assessments at eighteen months, three years, and five years
  • Exercises to strengthen mouth and palate muscles
  • Practice with specific sounds that are difficult to produce
  • Techniques to reduce nasal-sounding speech
• Dental and Orthodontic Treatment
  • Regular dental checkups to monitor tooth health and development
  • Orthodontic braces to straighten teeth and improve alignment
  • Appliances to expand the upper jaw if it is too narrow
  • Treatment for missing or extra teeth