Cleft palate

A cleft is a hole or gap affecting the tissues in the palate (roof of the mouth). This information sheet from Great Ormond Street Hospital (GOSH) explains the symptoms, causes and treatment of cleft palate and where to get help.

The size of the cleft palate varies from child to child – some children may only have a tiny notch whereas in others, the cleft may stretch from the front of the mouth to the back. Cleft palate is a relatively common condition, affecting around one in 700 babies.

Clefts occur early in pregnancy when the head and neck and forming. For reasons we do not yet know, the two halves do not join together as they should. This leaves a gap in the palate. Doctors think that a combination of genetic and environmental factors may cause clefts but more research is needed. Most cases of cleft palate occur sporadically (out of the blue) although some children have parents or other relatives who have also had a cleft palate.

Cleft palate can also develop as part of a syndrome – a collection of symptoms often seen together. There are around 100 syndromes that feature cleft palate. The doctors will examine your child closely to check for any other symptoms.

The cleft in the palate means that the baby will find it difficult to form a seal around the breast or bottle so will find sucking hard – this can have an immediate effect after birth on feeding. There are specific soft bottles available to assist with this problem – mothers can express their breast milk to give using this bottle.

In childhood, children with cleft palate seem to be at an increased risk of glue ear. This is also called ‘otitis media with effusion’, which means the middle ear contains fluid. It occurs when a sticky fluid (glue) builds up inside the ear. This can affect hearing because the parts of the middle ear cannot move freely, although the level of hearing loss is mild to moderate, rather than severe or profound.

After palate repair, children may continue to have a few issues with their speech. Velopharyngeal insufficiency (VPI) is the term used when the palate (roof of the mouth) does not close the nose off from the back of the mouth completely when speaking. VPI results in a ‘nasal’ voice, makes consonant sounds more difficult and can contribute to a delay in speech and language development.

Unlike a cleft lip, cleft palate can rarely be diagnosed during routine prenatal ultrasound scans at around 20 weeks. After birth, the cleft palate may be clearly visible, particularly if it is quite large. Otherwise, it may be picked up during a routine check-up when the midwife or doctor should use a tongue depressor and torch to examine  the palate closely – a  booklet from the Royal College of Paediatrics and Child Health explains more about this check-up. For a proportion of babies, the cleft palate is not obvious and is not identified soon after birth and only becomes apparent when feeding problems develop.

When a child is diagnosed with a cleft palate they will be referred to their local specialist cleft centre – Great Ormond Street Hospital (GOSH) hosts the North Thames Cleft Lip and Palate Service jointly with Broomfield Hospital in Essex. The service is the largest in the UK and the team works across both sites providing treatment to an average of 150 to 170 new babies per year born with a cleft lip and/or palate.

All children diagnosed with palate in the UK follow a similar treatment pathway, with the aim of improving outcomes for all children. As a rough guide, cleft palate repair surgery happens when your child is between nine months and a year old.

Further surgery may be needed at various stages of childhood and adolescence, such as pharyngoplasty and buccinator flap surgery both of which improve the function of the soft palate at the back of the mouth. In addition to surgery, your child will have support from other professionals to support their hearing and speech.

Young people will continue to be monitored throughout childhood and adolescence and may need further support. There are few long term effects of cleft palate and children grow up to lead normal lives, studying and working.