Best Way to Manage Cleft Lip and Palate

It is a common birth defect in which there is a cleft (split) in the lip/palate. A child may only have a cleft lip with normal palate or both may be involved. The incidence is 1/500 to 1/2,500 births. It is more commonly seen in boys. With modern plastic surgery these defects can be closed with good cosmetic results.

Apart from the psychological trauma of having an abnormal child, the first problem the parents face is that of feeding, especially if there is a cleft palate. The baby may seem to choke, and milk may come out through the nose. Other issues to be kept in mind are the speech development and dental eruption. These babies are also prone to get ear infection due to milk leaking into the ear canal.

Babies with only cleft lip (without cleft palate) generally have no difficulty in breastfeeding. While feeding the mother should put nipple as well as areola (dark portion of the breast around the nipple) inside the baby's mouth. The breast thus closes the cleft and the baby is able to suckle well.

It's a good idea to feed the babies with cleft lip/plate in a more upright position. Some Pediatricians recommend that the mother should sit up on the bed and hold the baby upright opposite her breast. The legs of the baby are along her sides and the feet are at her back. Now with one hand the mother supports the baby's back and with the other she hold the head to offer the breast.

Direct suckling may not be possible in babies with a large cleft. Specialized bottles and nipples may be required to accomplish adequate feeding. Or the milk can be expressed and given to the baby with a dropper or through a tube.

The surgical correction of a cleft lip is generally done at the age of 3 months. The baby should be thriving well and the weight should be around 5 kg. The cleft plate is usually operated upon between the ages of 1 and 2 years. This surgical correction may be done in 2-4 stages with surgical priorities being prevention of choking while feeding, enabling of speech production and of course, good cosmetic result. In patients with delayed surgical correction due to any reason, a prosthesis (a device to cover the defect) may be required.