is a common birth defect
, occurring once in every 500 births. It is a perforation
of the normal structure of the palate
(roof of the mouth). It may be a cleft
of the hard palate
, the soft palate
, a sub mucous cleft palate
or a combination of these things. Children with clefts of the palate may also have a cleft lip
. Combinations of cleft lip and palate occur once in every 1000 births. Jaws and teeth may also be affected.
Cleft palates can be treated. In the US a cleft palate team, consisting of various combinations of pediatricians, surgeons, lactation consultants, speech therapists, genetic counselors, dentists, nutritionists, audiologists, psychologists, social workers and nurses, typically treats them. Cleft palate teams usually arrange for all specialists to see the family at one visit in one location and when the team is good they coordinate their efforts and recommendations, saving the family much stress. The child will also have a primary pediatrician for treatment of non related conditions and well baby care.
Cleft palates can cause serious problems with breastfeeding as the normal seal of the oral cavity can not be formed while feeding and so the negative pressures needed for effective breastfeeding are compromised. This is because the hole in the roof of the mouth (the palate) is open to the hole in the nose (the nares) and therefore no seal can be formed in the oral cavity. Normally the lifting of the uvula and the soft palate seals the oral cavity off from the nasal cavity during suckling. If the cleft is large enough the positive pressure of the tongue lifting against the palate to express milk is also compromised. Various techniques can be employed to ameliorate these problems but often they are not effective enough to allow total direct breastfeeding. This does not preclude feeding of mother’s milk. Cleft palate affected babies who are fed formula all suffer from severe and almost continuous ear infections. These are greatly reduced by feeding breastmilk. When direct breastfeeding can’t be accomplished the mother should still use a breast pump and feed her expressed breastmilk to her cleft affected infant.