Birth defects

• Birth defects can cause disabilities and even death.
• Alcohol and drug use while pregnant can cause birth defects.
• Ask your provider what you can do to prevent birth defects.

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A cleft lip is a birth defect in which a baby's upper lip doesn’t form completely and has an opening in it. A cleft palate is a similar birth defect in which a baby’s palate (roof of the mouth) doesn’t form completely and has an opening in it. These birth defects are called oral clefts.

How does a cleft lip affect a baby’s face?
Some babies with cleft lip have just a small notch in the upper lip. Others have a complete opening or hole in the lip that goes through the upper gum to the bottom of the nose. A cleft lip can happen on one or both sides of a baby’s mouth.

How does a cleft palate affect a baby’s mouth?
A cleft palate can affect the soft palate (the soft tissue at the back of the roof of the mouth) or the hard palate (the bony front part of the roof of the mouth). A cleft palate can happen on one or both sides of a baby’s palate.

Do cleft lip and cleft palate always happen together?
No. Some babies have just a cleft lip. But most babies with a cleft lip also have a cleft palate. Some babies have only a cleft palate, which is called an isolated cleft palate.

What problems can oral clefts cause?
Babies and children with oral clefts may have:

• Feeding problems 
• Ear infections and hearing loss
• Speech problems 
• Dental problems 

When do oral clefts happen?
Oral clefts happen very early in pregnancy. Your baby’s lips are formed by about 6 weeks of pregnancy. Your baby’s palate is formed by about 10 weeks of pregnancy. Oral clefts happen when your baby’s lips or palate or both don’t form completely.

What causes oral clefts?
We’re not sure what causes oral clefts. Some possible causes are:

• Changes in your baby’s genes. Genes are part of your baby’s cells that store instructions for the way the body grows and works. They provide the basic plan for how your baby develops. Genes are passed from parents to children.
• Not getting enough folic acid before pregnancy. Folic acid is a vitamin that can help protect your baby from birth defects of the brain and spine called neural tube defects. It also may reduce the risk of oral clefts by about 25 percent.
• Taking certain medicines, like anti-seizure medicine, during pregnancy
• Smoking during pregnancy. Smoking causes 1 in 5 (20 percent) oral clefts.
• Drinking alcohol during pregnancy
• Having certain infections during pregnancy

Can oral clefts be prevented?
Not all clefts can be prevented. But there are things you can do to help reduce your chances of having a baby with an oral cleft:

• Before pregnancy, get a preconception checkup. This is a medical checkup to help make sure you are healthy before you get pregnant.
• Before pregnancy, take a multivitamin with 400 micrograms of folic acid in it every day.
• During pregnancy, take a prenatal vitamin with 600 micrograms of folic acid in it every day.
• Talk to your provider to make sure any medicine you take is safe during pregnancy.
• Your provider may want to switch you to a different medicine that is safe during pregnancy.
• Don’t smoke.
• Don’t drink alcohol.
• Get early and regular prenatal care.

How are oral clefts treated?
In most cases, oral clefts can be repaired by surgery. Each baby is unique, but surgery to repair cleft lip usually is done at 10 to 12 weeks of age. Surgery for cleft palate usually is done between 9 and 18 months of age. Your child may need more surgery for oral clefts as he grows.

Your baby gets treated by a team of specialists. Most teams include:

• Pediatrician. This is a doctor who has special training in taking care of babies and children.
• Plastic surgeon. This is a doctor who repairs or rebuilds parts of the body to improve how they work and look.
• Pediatric dentist. This is a dentist who has special training to care for the teeth of babies and children.
• Orthodontist. This is a dentist who fixes tooth defects and straightens teeth with braces and other methods.
• Otolaryngologist or ear, nose and throat specialist (also called ENT). This is a doctor who treats problems of the ears, nose and throat.
• Speech or language specialist. This is a person trained to help with speech problems.
• Audiologist. This is a person trained to measure hearing loss and fit hearing aids.
• Genetic counselor. This is a person trained to know about genetics, birth defects and other medical problems that run in families.
• Social worker. This is a person trained to help find resources and programs, such as health care and special services, for people with disabilities.

How common are oral clefts?
About 6,800 babies in the United States are born with oral clefts each year.

• Cleft lip and cleft palate affects about 4,200 babies each year. It is more common in Asians and certain Native Americans.
• Nearly 2,600 babies are born with isolated cleft palate each year. Isolated cleft palate affects babies of all races about the same.

Can other birth defects happen along with oral clefts?
Yes. There are about 400 health conditions (called syndromes) that are related to oral clefts. If your baby has an oral cleft, his provider checks him thoroughly for other birth defects soon after birth.

Are oral clefts more common in some families?
Yes. If you have family members with oral clefts, you may be more likely to have a baby with an oral cleft. If neither you nor your partner has a cleft but your baby does, and if your baby doesn’t have any kind of syndrome, the chance of you having another baby with a cleft is about 2 to 5 out of 100 (2 to 5 percent).

If you have a family history of oral clefts, or if you’ve had a baby with oral cleft, you can meet with a genetic counselor to find out the chances of having a baby with oral cleft. To find a genetic counselor, you can ask your provider or contact the National Society of Genetic Counselors.

For more information
Cleft Palate Foundation