How Are Cleft Lip And Cleft Palate Diagnosed
Because clefting causes very obvious physical changes, a cleft lip or cleft palate is easy to diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If the clefting has not been detected in an ultrasound prior to the baby’s birth, a physical exam of the mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child’s birth. Sometimes diagnostic testing may be conducted to determine or rule out the presence of other abnormalities.
Causes And Risk Factors
The causes of orofacial clefts among most infants are unknown. Some children have a cleft lip or cleft palate because of changes in their genes. Cleft lip and cleft palate are thought to be caused by a combination of genes and other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy.
Like the many families of children with birth defects, CDC wants to find out what causes them. Understanding the factors that are more common among babies with a birth defect will help us learn more about the causes. CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study and the Birth Defects Study To Evaluate Pregnancy exposureS , to understand the causes of and risks for birth defects, including orofacial clefts.
Recently, CDC reported on important findings from research studies about some factors that increase the chance of having a baby with an orofacial cleft:
CDC continues to study birth defects, such as cleft lip and cleft palate, and how to prevent them. If you are pregnant or thinking about becoming pregnant, talk with your doctor about ways to increase your chances of having a healthy baby.
Diagnosis Of Cleft Palate And Lip
Its possible for cleft palate and lip to be diagnosed while your baby is still in the womb through the use of an ultrasound. An ultrasound uses high frequency sound waves to create an image of your baby inside your abdomen.
If your doctor discovers that your baby has a cleft palate or lip while in the womb, they may want to remove some of the amniotic fluid that surrounds your baby to have it tested for other genetic abnormalities, such as van der Woude syndrome.
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Cleft Lip And Cleft Palate
A cleft lip is an opening or gap in the upper lip, often connecting to the nostril.
A ‘cleft palate’ is an opening in the roof of the mouth connecting with the canal of the nose.
Usually 1 in about 800 children is born with a cleft lip, cleft palate, or both.
Babies with these conditions often have trouble sucking, and may choke or gag on food that gets into their nose. Usually breast feeding is the best way to feed these children.
Make every effort to have the defects corrected by surgery since this can greatly improve the child’s looks, eating ability, and speech. The best age for surgery is usually at 4 to 6 months for the lip and about 18 months for the palate.
To prepare for surgery, parents should frequently stretch the deformed lip, so that the 2 sides meet in the middle.
Even after the cleft lip and palate have been successfully repaired, speech problems often occur. The family should gently encourage the child to speak as clearly as she can. Lip and tongue exercises may help . The child who cannot get surgery may need to learn sign language, using her hands to help people understand her .
Testing For Cleft Lip And Palate
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 like it comes out of his nose. This may be a clue that there is a cleft palate.
You should have your childs 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.
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Cleft Lip And Normal Adulthood
Cleft lip is a common birth defect which can be repaired through surgery. New research also suggests that parents dont need to worry about their children having long-term health problems.
This may not be true for children who have cleft palate, according to Norwegian researchers.
A cleft lip occurs when the tissue which forms the lip doesn’t completely join prior to birth. This results in an opening in the upper lip. A cleft palate occurs when the tissue on the roof of the mouth does not fuse together during pregnancy.
Researchers found that babies who were born with cleft lip and/or cleft palate, were not at a greater risk for additional health issues or for early death. Infants who were born with a cleft palate alone, however, were found to have a slightly increased risk of premature death and of having other issues such as an intellectual disability, autism or a severe learning disability.
“These results are relatively good news for parents of children with cleft lip and cleft palate,” said Dr. Erik Berg, who was the lead researcher at the University of Bergen.
One of the studys limitations was the small sample size of patients who had a cleft palate and died early or had developmental issues. As a result, it is not possible to effectively determine the extent of the risk for any specific outcome. The study was only able to identify the association between a cleft palate and an increased risk of future problems.
What Can Be Done For The Childs Speech From The Beginning Of Infancy Until School
Most importantly early on is to treat the child as you would any other child, meaning talk to the child, expose the child to lots of good language. That is necessary for all of us to learn speech normally. Then, by the time your child is a year old, he or she will begin to produce their first words, and an evaluation by a speech pathologist is indicated. In fact, it is a good idea to see a speech pathologist earlier than that, such as during the months when the child is beginning to babble. Once that begins to happen, we can get an idea about whether the cleft is affecting the childâs speech. It is important to note that only between 20 and 30 percent of children born with clefts of the palate have speech problems requiring secondary surgery after the palate is repaired. The remaining 70 to 80 percent develop speech normally.
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Will A Cleft Lip And Palate Happen Again
Most cases of cleft lip or palate are a one-off and it’s unlikely you’ll have another child with the condition.
The risk of having a child with a cleft lip or palate is slightly increased if you’ve had a child with the condition before, but the chances of this happening are thought to be around 2 to 8%.
If either you or your partner were born with a cleft lip or palate, your chance of having a baby with a cleft is also around 2 to 8%.
The chances of another child being born with a cleft or of a parent passing the condition to their child can be higher in cases related to a genetic condition.
For example, a parent with 22q11 deletion syndrome has a 1 in 2 chance of passing the condition to their child.
Treatment Of Cleft Palate And Lip
The treatment for your childs cleft palate or lip will depend on the severity of the condition. Treatment often involves several surgeries to close the opening and reconstruct the face.
A team of specialists may work with you and your child. For example, if your child has problems with speech because of their cleft, they might work with a speech pathologist. Your childs team may also include a plastic surgeon, an oral surgeon, and/or an orthodontist.
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Cleft Palate And Intellectual Disability Profound
Mendelian tool does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. It does not diagnose, it produces a ranked list of suspected genes which provide assistance for rare hereditary disease cases. Patients should discuss their findings with their healthcare providerThis service is using Human Phenotype Ontology . Find out more at www.human-phenotype-ontology.org.
Cleft Palate: Frequently Asked Questions
Cleft palate is the most common birth defect that occurs. It happens in about 1 in 700 births. It is not a fatal problem. Most children born with clefts do well in developed countries. They may have difficulties with feeding initially, but with proper guidance, parents learn to feed their child with a cleft, and the child learns to compensate for the cleft during the first months after birth. Clefts are repaired within the first year of life, usually by a surgeon who has extensive experience and training with this disorder. The clefts are repaired in part to facilitate feeding, but most importantly to support normal speech. It is the problems with speech that I’d like to focus on.
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If You Have Questions Or Concerns Share Them
Ask for a meeting with the school and write down your questions beforehand.
Your questions might include:
- How will the school make sure that the cover staff, kitchen staff and break time staff are aware of any additional needs?
- How will the school work with external agencies such as Speech and Language Therapists?
- Who is responsible for making sure your childs support plan is carried out?
- How will the school approach studying potentially sensitive subjects, such as teeth?
- How can my child access work or catch up with the class when they take time off for operations?
Does Everyone With A Cleft Palate Have To Have Surgery What If They Don’t
Many children in third world countries do not have the luxury of having surgery. They may grow up with unrepaired clefts. The implications include social isolation, speech problems, and feeding problems. In this country, we are fortunate to have the resources and expertise to provide cleft care for all babies born with cleft. So there is no reason for children in this country to grow up with an unrepaired cleft palate. The primary reason for repairing clefts includes appearance and speech development, as well as maximizing the health of the ears and facilitating eating. Submucous cleft palates may not need to be repaired and speech and feeding needs dictate the necessity of any surgery for these.
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How Can I Help Prevent Birth Defects In My Child
Researchers are trying to find ways to prevent many birth defects. Not all birth defects can be prevented. There are only a few ways currently known to help prevent certain defects. Taking steps to be healthy before and during pregnancy is important. Getting vaccinated against certain infections such as rubella can prevent birth defects caused by that infection. Not drinking during pregnancy can prevent birth defects caused by alcohol. Taking a prenatal vitamin that includes folic acid can help prevent neural tube defects such as spina bifida.
Prevention Of Birth Defects
It is not possible to prevent ail birth defects. There are, however, ways to make it less likely that children will be born with birth defects.
Eat well during pregnancy.
Avoid marrying close relatives. If you already have one or more children with a birth defect, consider not having more.
Avoid all medicines during pregnancy unless you are sure they will not damage the baby. Avoid any contact with pesticides and other poisons. Tobacco and alcohol during pregnancy can also damage the developing child.
While pregnant, stay far away from children with German measles if you have never had it. If you are not pregnant, try to catch it before you get pregnant. Vaccine exists for German measles, but is not often available.
Consider not having more children after age 35 or 40, or if you have had one child with Down syndrome, since the chance of having another is increased.
Cleft Lip Abortion Done In Good Faith
Doctors and health officials will consider whether more guidance on abortions is needed following the decision of the Crown Prosecution Service not to prosecute two doctors who authorised a late abortion on a foetus with a cleft lip and palate.
Jim England, the chief crown prosecutor for West Mercia, said the doctors believed, in good faith, that there was a substantial risk the child would be seriously handicapped. âIn these circumstances, I decided that there was insufficient evidence for a realistic prospect of conviction and that there should be no charges against either of the doctors,â he said.
The inquiry began after a legal challenge over a previous decision by police not to charge the doctors involved in the abortion carried out, in 2001, on an unnamed woman from Herefordshire who was more than 24 weeks pregnant.
Joanna Jepson, 28, now at St Michaelâs Church, Chester, but then a trainee vicar, found out about the procedure in 2002 when studying abortion statistics and suggested that it amounted to unlawful killing.
Yesterday Ms Jepson said: âWhile Iâm disappointed about the CPSâs decision to drop the case, I am pleased the case has raised the issue of late-term abortion and the plight of disabled babies in late-term pregnancy. It has exposed grave discrimination and I will be seeking legal advice.â
How Can The Clinical Psychologist With The Cleft Team Help
The Clinical Psychologist with the Cleft Team can use playing and talking therapies to help children feel better, behave differently, or think in a more helpful way. They are not psychiatrists and do not prescribe medication, they are cleft specialists who understand the specific support needs of people with a cleft and their families.
Treatment will vary from child to child.
First, there will be an assessment where you and your child will be invited to meet the Clinical Psychologist so you can all get to know each other and explore any issues in a safe environment. This may involve questionnaires, and the Psychologist may need to contact your childs school.
Next, the Clinical Psychologist puts all this information together to try and understand what is causing these issues.
Finally, the Clinical Psychologist decides what kind of therapy is likely to work best in this situation.
This can involve working with the child to help them feel better about themselves, coming up with strategies to deal with unwanted questions or to manage teasing or bullying, or even putting children in touch with each other so they can talk to someone else in a similar situation. The psychologist may also work with the family to help them understand how to best support their child.
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What Kind Of Follow Up Is Needed After Surgery
After surgery, it is really important for the family to follow up with the cleft surgeon to ensure that the healing process is progressing the way it should. There is always a risk of infection and breakdown of sutures at the surgical site, and so it is very important that the family stay in close contact with the surgeon post-operatively.
Cleft Lip And Palate Diagnosis And Treatment
For most infants with cleft lip alone, your childs surgeon can repair the abnormality within the first several months of life. To repair a cleft lip, the plastic surgeon uses a special technique to suture the two sides of the lip together, leaving a scar that blends into the lip. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 6 to 18 months. This is a more complicated surgery, and it is done when the baby is bigger and better able to tolerate the surgery. Your childs doctor will advise about the exact timing of the surgery. To repair a cleft palate, the plastic surgeon uses tissue from either side of the mouth to fill in the gap. A second operation may be required.
At your first visit with the plastic surgeon, he or she will explain the details of the surgery, risks, complications, costs, recovery time and outcomes.
The Johns Hopkins Cleft and Craniofacial Center
Each year, the Johns Hopkins Cleft and Craniofacial Center treats approximately 650 babies and children with cleft lip and palate or other craniofacial conditions. Our goal is to help our patients achieve their full potential, without being defined or limited by facial differences.
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