The emotional impact of cleft lip and cleft palate can be profound for both the affected child and their family.

A cleft lip or cleft palate is a congenital condition that affects the formation of the upper lip and/or the roof of the mouth. Here is a brief overview of each:

 

Cleft Lip:

 

A cleft lip is an opening or split in the upper lip. This split can occur on one or both sides of the lip and may extend up to the nose.

 

It can range from a small notch in the lip to a complete split that extends into the base of the nose.

 

Causes: The exact cause is often unknown, but it can be due to genetic factors, environmental factors, or a combination of both. Factors like maternal smoking, diabetes, and certain medications during pregnancy can increase the risk.

 

Cleft Palate:

 

A cleft palate is an opening or split in the roof of the mouth (the palette). It can involve the hard palate (the front part of the roof of the mouth) or the soft palate (the back part of the roof of the mouth) or both.

 

Appearance: This condition may involve just a small opening or a large gap that affects the mouth and nasal cavity.

 

Causes: Similar to cleft lip, the exact causes can include a combination of genetic and environmental factors.

 

Complications due to Cleft Lip or Palate

 

• Feeding Difficulties

  Infants born with a cleft lip or cleft palate often face significant challenges when it comes to feeding. The primary issue arises from the gap or split, which interferes with the baby’s ability to create the necessary suction for effective breastfeeding or bottle feeding. This difficulty in creating suction can lead to inadequate nutrition and slow weight gain.

  Additionally, milk or formula may enter the nasal cavity through the cleft, causing discomfort and increasing the risk of choking. Specialized feeding bottles and techniques are often required to ensure that these infants receive the nutrition they need.

• Speech Difficulties

• Ear Infections

  Children with a cleft palate are at a higher risk for frequent ear infections, known as otitis media. This increased risk is due to the improper function of the eustachian tube, which helps drain fluid from the middle ear. In a child with a cleft palate, the muscles that control the eustachian tube may not work properly, leading to fluid build-up and subsequent infections. These recurrent ear infections can result in temporary or even permanent hearing loss if not effectively managed.

  Regular monitoring by an ear, nose, and throat (ENT) specialist is essential, and many children may require the insertion of tympanostomy tubes (ear tubes) to help drain fluid and prevent infections.

• Dental Problems

  Dental issues are common among children with cleft lip and palate. The alignment of the teeth can be affected, leading to malocclusion, where the teeth do not meet properly when the jaws are closed. This can cause difficulties in chewing and speaking, and may also affect the child’s appearance, potentially leading to self-esteem issues.

  In addition to misalignment, these children are more prone to tooth decay and other dental problems due to difficulties in maintaining oral hygiene around the cleft area. Regular dental care is crucial, and many children will need orthodontic treatment to correct the alignment of their teeth. This may include braces or other orthodontic appliances, and in some cases, additional surgeries may be necessary to address more severe dental issues.

Coping with Cleft lip & Cleft Palate

 

The emotional impact of cleft lip and cleft palate can be profound for both the affected child and their family. Children may face social challenges, including bullying and self-esteem issues, due to their appearance and speech difficulties. Parents often experience stress, anxiety, and guilt, worrying about their child’s well-being and future.

 

Dealing with these emotional challenges requires comprehensive support. Psychological counselling can help both children and parents manage feelings of anxiety and build resilience. Support groups provide a community where families can share experiences and advice. Encouraging open communication within the family helps address concerns and fosters a supportive environment.

 

Additionally, involving the child in speech therapy and social skills training can boost confidence and improve interactions with peers. Educating peers and teachers about cleft conditions can promote understanding and reduce stigma. A multidisciplinary approach ensures that emotional, social, and medical needs are met, leading to a better quality of life.

 

How is Cleft Lip & Cleft Palate treated?

 

• Surgery

  The cornerstone of treatment for cleft lip and palate is surgical repair. For a cleft lip, surgery is usually performed within the first few months of life, often between 3 to 6 months. This early intervention is crucial to ensure proper feeding and to begin the process of normal facial development. Cleft palate repair is generally carried out a bit later, typically within the first 18 months of life. This timing allows for the growth necessary to perform a successful repair while minimizing speech and feeding difficulties. Multiple surgeries may be required as the child grows to address functional and aesthetic aspects, ensuring the best possible outcomes.

• Speech Therapy

  Speech and language development can be significantly impacted by cleft palate, necessitating ongoing speech therapy. Children with cleft palate often struggle with producing certain sounds and may have hyper nasal speech. Early and regular sessions with a speech-language pathologist are essential to help these children develop clear and effective communication skills. Therapy focuses on correcting speech patterns and improving articulation, often continuing through the school years to support language development.

• Dental Care

  Comprehensive dental care is another critical component of treatment. Children with cleft lip and palate often face dental issues such as misaligned teeth, malocclusion, and an increased risk of tooth decay. Regular visits to a paediatric dentist are essential, and orthodontic treatment, such as braces, is often required to correct alignment issues. In some cases, additional surgeries may be needed to address severe dental problems, ensuring proper function and appearance.

• Multidisciplinary Support

  Effective treatment of cleft lip and palate requires a multidisciplinary care team. This team typically includes surgeons, orthodontists, speech therapists, and psychologists, who work together to provide comprehensive care. Coordinated efforts ensure that all aspects of the child’s development, from physical health to emotional well-being, are addressed. This comprehensive approach is vital for achieving the best possible outcomes for children with cleft lip and palate.

Cause and Risks for Cleft Lip & Palate

 

Cleft lip and cleft palate are congenital conditions that arise from disruptions in the normal development of the face during early pregnancy. The exact cause of these conditions can vary and often involves a combination of genetic and environmental factors. Here are some of the common causes and risk factors associated with cleft lip and cleft palate:

 

• Genetic Factors
  • Family History: If one or both parents have a cleft lip or palate, or if there is a family history of these conditions, the risk increases for the child.
  • Genetic Mutations: Certain genetic mutations can interfere with the normal development of the lip and palate, leading to cleft formation.
• Environmental Factors
  • Maternal Smoking: Smoking during pregnancy significantly increases the risk of having a baby with a cleft lip or palate. The harmful substances in cigarettes can affect the baby’s development.
  • Alcohol Consumption: Drinking alcohol during pregnancy can disrupt foetal development and increase the risk of cleft lip and palate.
  • Medications: Some medications taken during pregnancy can increase the risk of cleft formation. These include certain anticonvulsants, acne medications containing isotretinoin, and methotrexate, which is used for treating cancer and autoimmune diseases.
  • Psychoactive agents: Instances of psychoactive substances encompass ethanol, caffeine, nicotine, cannabis, and specific analgesics.
• Nutritional Factors
  • Folic Acid Deficiency: Adequate folic acid intake during pregnancy is crucial for the proper development of the baby’s neural tube and other tissues. A deficiency in folic acid has been linked to an increased risk of cleft lip and palate.
  • Poor Nutrition: Overall poor nutrition during pregnancy can affect foetal development and increase the risk of congenital anomalies, including cleft lip and palate.
• Health Conditions
  • Diabetes: Pregnant women with diabetes, particularly if it is not well-controlled, have a higher risk of having a baby with a cleft lip or palate.
  • Obesity: Maternal obesity has been linked to an increased risk of various birth defects, including cleft lip and palate.
• Other Factors
  • Infections: Certain infections during pregnancy can increase the risk of cleft lip and palate.
  • Exposure to Chemicals: Exposure to certain environmental chemicals and pollutants during pregnancy can increase the risk of cleft formation.

Multifactorial Inheritance

 

In many cases, cleft lip, and palate result from a combination of genetic predisposition and environmental influences. This multifactorial inheritance means that several genes might interact with environmental factors to cause the condition.