One of the most common congenital problems that occur in newborn infants are cleft deformities: cleft lip and cleft palate. They result from incomplete development of the lip or the palate during pregnancy. Though these congenital problems have been studied extensively, it is still not known exactly what causes them. It is however well understood that they are not due to something particular that the mother did during pregnancy.

Proper care of an infant with a cleft deformity may involve the help of a variety of health professionals. In addition to surgery to repair the defects there may be other associated issues. Speech and hearing may be affected, requiring the care of an otolaryngologist and a speech pathologist. Dentition may also be affected, requiring the care of an orthodontist specialized in this type of care.

When will the repairs take place?

Initial closure of the cleft lip may take place at 2-4 weeks of age. This surgery is done as an outpatient. The more detailed repair takes place at 4-6 months of age. This is also done as an outpatient procedure. The palate is repaired at approximately 12-18 months of age. This surgery requires at least one night in the hospital. It is important to be sure that your child is well hydrated and able to eat prior to discharge.

Where are the incisions placed?

With lip repair an incision is placed from the lip up toward the nose. It is visible and will fade with time. Scar revision and lip revision may be needed as the child grows.

What happens the first day or two after surgery?

Your child will be placed in "no-no" restraints. These are soft restraints that prohibit your child from bending her elbows. The surgical repair can be destroyed easily by the insertion of a fist in the mouth or by picking or rubbing the lips. The tape dressing will fall off on its over the next few days. Internal sutures will dissolve spontaneously and do not need to be removed.

Your child may be a bit cranky the first day or two. Discomfort can be easily controlled with pain medication.

What complications are possible?

As with nearly any surgery, delayed healing or infection is a risk. In rare cases there may be poor healing of the palate, which may lead to the need for a second surgical repair.

Will my baby's feeding be affected?

Feeding a baby with a cleft lip or palate can present a large challenge to the mother. When a cleft lip is present it is hard for the baby to close tightly around the nipple. When a cleft palate is present the baby has difficulty sucking. Because of this the following things may happen:

• Feeding will take longer, resulting in a tired and irritable baby
• Excess air may be swallowed resulting in stomach discomfort, vomiting or spitting up
• Food may be lost through the nose resulting in irritation
• Food may go into the trachea resulting in coughing or choking
• Your baby may not get enough milk or formula resulting in a failure to gain weight and hunger

Your pediatrician should provide you with detailed information about feeding.

How do we deal with this birth defect?

It is important to be honest and direct with your family and friends about the defect. Provide them with information that you have collected and received from your doctors. There is every reason to expect that your baby will develop normally. They will thrive on love and attention. Seek out an environment of health professionals that encourage you to treat your baby as any other newborn.

Many people have overcome this birth defect and lived productive, successful lives. Outstanding, comprehensive care is available to manage all aspects of cleft deformities.