Management strategies that support the child with a cleft lip and/or palate

A cleft is a gap or split in the upper lip and/or roof of the mouth (palate). It is present from birth. The gap is there because parts of the baby’s face didn’t join together properly during development in the womb. A cleft palate may just be an opening at the back of the mouth, or it may be a split in the palate that runs all the way to the front of the mouth.

A cleft lip or palate happens when the structures that form the upper lip or palate fail to join together when a baby is developing in the womb.  child can have a cleft lip, cleft palate, or both. Clefts can happen on only one side of the face or on both sides. A cleft can go only part way through the lip or palate or all the way through. Sometimes there is an opening in the bony part of the palate that is covered by a layer of thin tissue. You may not be able to see this opening because it is covered. This is called a sub mucous cleft palate.

A cleft palate leaves an opening between the roof of the child’s mouth and his nose. Many clefts are found after the baby is born. Sometimes a cleft can be seen before birth on an ultrasound. If the cleft is not easy to see, it may not be noticed until your baby has trouble feeding. Milk may come out of her nose. Some clefts aren’t found until after the child starts talking and sounds like she is talking out of her nose.

Orofacial clefts, especially cleft lip with or without cleft palate, can be diagnosed during pregnancy by a routine ultrasound. They can also be diagnosed after the baby is born, especially cleft palate. However, sometimes certain types of cleft palate (for example, submucous cleft palate and bifid uvula) might not be diagnosed until later in life.

Cleft palate can present obvious social challenges for the baby’s parents, and for the child themselves as they get older, if the condition is left untreated. Parents usually dream of having a “perfect” baby, and they may feel disappointed when they realize that their newborn baby has a cleft. They may go through many emotions, including shock, denial, sadness, and anger, before they can finally accept what is happening. Many parents do not realize how successful surgery can be in correcting these abnormalities.

If left untreated, cleft lip and palate can present other challenges for a baby, including problems with feeding, hearing, dental development, and speech.


Management strategies that support the child with a cleft lip and/or palate

  • Speech Therapy can help with any feeding issues before and after the cleft repair and to monitor speech production during the first years of life.
  • Development of Speech Therapy goals specific to cleft speech errors.
  • Development of specific strategies to help reduce speech errors occurring to be practiced at home.
  • During feeding a baby with cleft lip will often need the mother to block the cleft with a finger or breast tissue to allow a seal around the teat or nipple so that sucking can occur efficiently.
  • Improving speech clarity: Developing strategies to eliminate the over use of “back sounds” such as /k/ and /g/: children with cleft palate often present with backing (i.e where the tongue hits the back of the mouth) such that their speech contains lots of /k/ and/or /g/ sounds and other back sounds which affects their speech intelligibility.
  • Confidence: Assistance in developing confidence and self-esteem.
  • Feeding program to help the child to achieve a seal over the breast or teat of a bottle.
  • Liaising with educational staff and other professionals involved in the child’s care regarding the nature of the difficulties and ways to help the child to access the curriculum.
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