Doc Talk: De-coding the Cleft Lip Phenomenon

 

cleft lip phenomenon in childrencleft lip phenomenon in children
A child with a cleft lip or palate requires a unique plan of care and comfort

 

An expecting mom is full of joy, dreaming of a new life and awaiting the arrival of her little one. But, sometimes at this nascent stage, certain developments may not happen as per schedule leading to a lesser known medical condition - the cleft lip. Here’s a low down on the causes and cure if your baby is born with a cleft lip.

 

Cleft Lip is a type of birth defect that occurs when the lip does not fully close within the first four to seven weeks of conception. 

 

This is one of the most common congenital deformities, also called craniofacial birth defects. It occurs at a rate of one per 500 to 700 births worldwide. 

 

The severity of the lip opening can be as minimal as a notch in the lip or a large gap from the top of the lip to the bottom of the nose. It can be associated with cleft in the palate (roof of the mouth). The split in the lip can be on one or both sides of the lip. 

 

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Causes:

 

There are unknown factors (genetic and environmental) that prevent this fusion process from fully closing the midline facial structures. 

 

Maternal smoking, alcohol use and folic acid deficiency can be associated with the development of cleft lip and palate in the foetus. Folic acid supplement has been known to reduce the incidence of cleft lip. 

 

About 20% affected kids have only the cleft lip, 30% have only the cleft palate, and 50% children with a cleft lip will also have a cleft palate. The risk of a second child having the cleft lip and palate is approximately 4 to 8%.

 

Underlying trouble:

 

Children with cleft lip may have a variety of health problems. Some children may need assistance with breathing, eating, and talking. Ear infections, loss of hearing, and teeth problems are common in children with cleft lip. Problems with adjusting to social situations may influence how the child learns and behaves.

 

Babies with cleft lip generally can’t feed well due to lack of suction. Breastfeeding is possible with extra patience and careful positioning. If not successful, the mother can extract milk and give it to the baby in a special feeder.

 

Treatment: 

 

Each child with a cleft lip and palate will have a unique plan of care and will need to be treated by a specialized interdisciplinary team (plastic/paediatric surgeon, paediatricians, dental specialists, otolaryngologists, speech therapist, dieticians, audiologists and geneticists).

 

Surgery to correct the cleft lip and palate will occur in stages, beginning with the lip repair at about three months of age.  The palate will be repaired later once the child’s facial structures have grown bigger in order to be able to successfully pull the tissues together (12 -18 months). Speech therapy is very helpful to children, who may learn to speak a bit later than other children because of the surgical procedures and discomfort.  However they will catch up with speech therapy, and in most cases their speech will be normal.

 

Children and families may benefit from counselling to support the child’s self- esteem and help with developing self-confidence and independence. This is a very visible defect that can make a child feel different and affect their self-confidence and body image. Focusing on the child’s strengths and abilities is very important throughout childhood.

 

This article is written by Dr Prashant Jain, Consultant, Paediatric Surgery, Department of Neonatal, Paediatric and Adolescent Medicine, BLK Super Speciality Hospital, New Delhi.

 

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Image courtesy: ©Thinkstock/ Getty Images

 

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