Cleft Palate

Treatment Overview

Surgery is the primary treatment for cleft palate. Sometimes multiple procedures are needed over several years to fully correct the defect. Additional treatments depend on the severity of cleft palate and whether other problems develop, such as speech or feeding problems. Some treatments, such as speech therapy, may continue into early adulthood.

Before surgery

Before surgery to correct a cleft palate, your baby may need treatment:

• For breathing difficulties. Some babies born with cleft palate have obstructed airways. Treatment depends on the severity of the problem. For example, some babies can be given oxygen through a tube in the nostrils. In rare cases, emergency measures are needed, such as a tracheostomy.
• For feeding difficulties. Babies with cleft palate usually have difficulty sucking and swallowing. A doctor or nurse can guide you on feeding techniques. Also, your baby will be closely monitored for signs of dehydration.
• To prepare the mouth for the surgery. Dental supports may be used immediately after birth or within the first 2 to 3 weeks of birth. These supports are made from plastic or metal molds (sometimes called a baby plate or obturator) to help reshape the tissues.

Surgical repair of cleft palate

Generally, surgery is performed between ages 12 months and 18 months to promote normal speech and language development.² Before age 6 months, surgical repair of cleft palate may cause problems with normal facial growth. In some situations, doctors may prefer to wait until the baby is 18 months of age, to avoid damaging the teeth buds or for other reasons related to your child's circumstances. Surgery to correct a cleft of the soft palate may be done earlier than surgery to correct a cleft of the hard palate. See a picture comparing a normal mouth and two types of cleft palate.

Additional surgeries may be needed as your baby grows and develops. The number and type of surgeries depend on how much of the palate is affected and other aspects of your baby's health, such as whether another facial defect or health condition is present. For example:

• A baby with a cleft of the soft palate may need only one surgery, which usually is done between the ages of 1 and 2. It sometimes is postponed until the child is between ages 5 and 7 years.
• A baby with a cleft that involves both the hard and soft palates may need several surgeries, beginning at birth and continuing until he or she is between 10 and 13 years of age.
• A baby who has cleft palate and other facial birth defects, including cleft lip, may need several surgeries, may have more complications, and may need additional treatment.

After surgery

After surgery to correct cleft palate, antibiotics are usually given for about 5 days.

Your baby's arm movements may be restricted with splints or other material for as long as 3 weeks. This measure is sometimes needed to prevent your baby from touching and damaging the stitches.

Babies with cleft palate have problems sucking and swallowing, so feeding can be challenging. Watch for signs of dehydration, which can develop if your baby is not getting enough breast milk or formula. Bottle-feeding is usually more successful than breast-feeding. Some mothers bottle-feed pumped breast milk. After surgery to repair a cleft palate, sucking often feels different to babies, and they must relearn proper techniques. During the adjustment period, your health professional can recommend strategies to help you make sure your baby gets enough nourishment.

Although surgery often leaves slight scars, usually the palate heals well after surgery, with very little evidence of the cleft. A child's facial bones typically grow normally, and the child speaks more clearly.

Other surgeries may be needed to correct the scars. Additional treatment for speech, teeth, and hearing loss, and emotional counseling may also be needed. Some children need to have ear tubes inserted surgically to help prevent ear infections.

Speech therapy may be needed as your baby grows and begins to talk. Speech therapy may continue through childhood. If additional surgeries are performed when your child is older, speech therapy may be reintroduced or adapted to meet new challenges.

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Author:	Debby Golonka, MPH	Last Updated: February 4, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Arden Christen, DDS, MSD, MA, FACD - Dentistry
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