Cleft lip and palate treatment

Prenatal ultrasound screening of your baby may detect cleft lips with or without cleft palates before he or she is born. If your doctor diagnoses your child's cleft lip or palate during pregnancy, our team is available for consultation.

Talking with specialists about cleft lip and palate and learning about the disorder can help parents prepare to care for their children so they will feel confident once their child is born.

Two of the special needs we'll address in the early stages include:

• Breathing
• Feeding

Your first meeting will include a nurse clinician and a plastic surgeon who will be able to answer your questions and help you begin to prepare.

Most of the time, cleft lips and/or palates are discovered at birth. We encourage parents to remember that clefts do not cause pain and their babies don't know they have a cleft. The two most important issues your child's medical team must address are:

• Ensuring your baby's airway is open and he or she can breathe and eat easily
• Helping you help your baby overcome the difficulties with sucking that can make feeding difficult.
  Babies with cleft palates are not able to suck well, and you may have to use special bottles and feeding methods to help. Our nurse clinician will teach you how to feed a child with a cleft and is available to address concerns and questions.
• Following growth and development closely.
  The Craniofacial/Plastic Surgery Programs at Children's and your child's pediatrician will monitor your child's development to make sure he or she is getting enough nutrition.
• Preparing for later surgery:
  Another important issue to consider is pre-surgical nasoalveolar molding therapy. This involves several visits in the early months to one of our specialists to try to reshape the lip, gums and nose before the first surgery in order to get a better long-term result. Not all children need this, but if it is recommended, we must provide this therapy early to have the best outcomes.

In some cases, the cleft is of the palate alone, and it is associated with a small lower jaw. Sometimes this is referred to as the Pierre Robin sequence. Severe forms of this disorder can cause the tongue to be positioned too far back in the throat and blocks the airway.

Pierre Robin sequence requires careful evaluation by the cleft team, and in some cases requires emergency surgery. Occasionally, clefts of the lip and palate can be associated with other problems in the form of a syndrome, though these are far less common than simple, unassociated cleft lips and palates.

Most babies will need surgery to repair the cleft(s). Usually, surgeons choose to repair a cleft lip between 3 and 6 months of age. This surgery may follow a period of 2 to 3 months of nasoalveolar molding therapy. Surgeons usually choose to repair cleft palates at about 1 year of age. Each operation usually requires a short hospital stay. At Children's, board-certified plastic surgeons with special expertise and experience in pediatric cases will perform these operations. The full-time plastic surgeons on Children's cleft team have years of experience and manage one of the largest cleft practices in the Midwest. They also contribute to physician training through their affiliation with the Medical College of Wisconsin.

Care of children with cleft lip and palate is more than a series of operations during childhood. While every child is different, many need additional evaluation and treatment.

At Children's, we customize care to each child. In most cases, our Cleft Lip and Palate team begins with a half-day evaluation around the age of 18 to 24 months.

Our team includes:

• Plastic surgeons – Our surgeons serve as medical directors of the team and manage surgical correction of the lips, palates and gums, as well as later surgical correction of the nose and jaws when growth is impaired. They also can correct with surgery some speech problems that may arise in these children.
• Speech-language pathology – Babies born with a cleft lip alone often develop normal speech, but babies with cleft palate can have speech problems if they do not get proper speech therapy. Some children need only speech and language therapy, while others also may need a prosthetic appliance and/or surgery to correct their speech problems.
• Otolaryngologist (Ear, Nose, and Throat) – Infants with cleft palate have frequent ear infections or fluid behind the eardrum. Most need to have ear tubes placed by an ENT specialist during the first year. In addition, ENT specialists will evaluate your child's airway.
• Audiology - Good hearing is necessary for good speech. Most babies born with a cleft lip alone have normal hearing. However, children with cleft palate may develop hearing problems. Fortunately, the team at Children's offers treatments to improve or correct hearing problems.
• Dental specialties – A pediatric dentist and/or an orthodontist with extensive experience working with clefts will examine the position and alignment of your child's teeth, which can be affected by the cleft. He or she will then offer treatment as needed. If your child cannot have surgery, a prosthodontist will work with him or her to provide an appliance that can help improve speech.
• Genetics – A genetic counselor can review your child's medical and family history and counsel you on the chances of having another baby with a cleft, as well as the chances your baby will have children with clefts. Genetic counselors also can detect other rare traits your child may have.
• Psychology – Normal emotional development is an important part of the overall health of these children, and often children with facial differences have difficulty interacting with their peers. Our trained team psychologist provides counseling to families to help them these issues.

Early intervention and long-term follow-up are the keys to achieving the best results for your child. Our cleft lip and palate team typically meets with children once a year. Some children will see their specialists more or less often as needed. Our team approach assures that your child gets the complete, coordinated care he or she deserves.