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Birth defects

  • Birth defects are health conditions present at birth.
  • They can cause problems in how the body works.
  • About 120,000 babies born each year have a birth defect.
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Clubfoot

Clubfoot (also called talipes equinovarus) is a birth defect of the foot. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops or in how the body works.

If your baby has clubfoot, one foot or both feet point down and turn in. This happens because the tissues that connect muscles to bone (called tendons) in your baby’s leg and foot are shorter than usual. This pulls the foot into an abnormal position. Babies with clubfoot also may have abnormal foot bones, ankle joints and muscles.

Clubfoot is a common birth defect. About 1 in 1,000 babies is born with clubfoot in the United States each year.

What problems does clubfoot cause?

Clubfoot can range from mild to serious. Clubfoot isn’t painful, and it doesn’t bother your baby until he begins to stand and walk. If it’s not treated, he may have problems walking correctly. For example, he may walk on the sides of his feet or even on the tops of his feet instead of on the bottoms or soles of the feet. Sometimes, the part of the foot he walks on abnormally can get infected, and the skin can get thick and hard. Clubfoot that’s not treated can cause arthritis. This is a health condition that causes joint pain, aches, stiffness and swelling.

How do you know if your baby has clubfoot?

Your baby’s provider can identify clubfoot and other foot problems in a physical exam of your baby after birth. Your baby’s provider may use other tests, like a foot X-ray.

Sometimes, your health care provider may see that your baby has clubfoot before birth using ultrasound. An ultrasound uses sound waves and a computer screen to make a picture of your baby in the womb. Even though clubfoot can’t be treated until your baby is born, knowing about it while you’re pregnant may help you plan ahead for treatment.

How is clubfoot treated?

A doctor with special training in bone conditions called an orthopedic surgeon can help you understand the best treatment for your baby. Until recently, many children with clubfoot had surgery to correct their condition. Now, most children with clubfoot can be treated without surgery. Treatment works best when it’s started early, even as early as 1 week old. With early treatment, most children with clubfoot can grow up to wear regular shoes and have active, normal lives.

Clubfoot treatment may include:

  • Stretching and casting (also called the Ponseti method). This is the most common treatment for clubfoot. It usually starts in the first 2 weeks of your baby’s life.For this treatment, your baby’s provider stretches your baby’s foot toward the correct position and then puts it in a cast. The cast goes from your baby’s toes to his upper thigh. Every 4 to 7 days, your baby’s provider takes off the cast, moves your baby’s foot closer to the correct position and puts on a new cast. Before your baby gets his last cast, his provider may cut the heel cord. This is the tendon that connects the heel to muscles in your baby’s calf. This allows the heel cord to grow to a normal length by the time the last cast comes off.This type of treatment usually fixes the problem in 2 to 3 months. After that, your baby can do stretching exercises to help keep his feet in the right position. He also may need to wear special shoes or a brace at night for a few years.
  • Stretching, taping and splinting (also called the French method). With this treatment, your baby’s provider stretches your baby’s foot toward the correct position and uses tape and splints to hold it that way. This treatment usually starts soon after birth and is done every day for 2 months and then less often until your baby is 6 months old. After this, you can use stretching exercises and night splints to help keep your baby’s feet in the right position until she starts to walk.
  • Surgery. If your baby’s clubfoot is severe or if stretching treatments don’t work, clubfoot can be treated with surgery. It’s best to have surgery before your baby starts walking. Surgery can help make the heel cord longer and fix other problems with the feet. After surgery, your baby may be in a cast for 6 to 8 weeks.

What causes clubfoot?

We don’t know what causes clubfoot, and there’s no way to prevent it. But some things may make a baby more likely than others to have the condition, including:

  • Your baby is a boy. Boys are twice as likely as girls to have clubfoot.
  • Your baby has another birth defect, like cerebral palsy or spina bifida.
  • You have clubfoot in your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. If you, your partner or one of your children has clubfoot, your baby’s risk of having clubfoot increases. If you already have a baby with clubfoot, your chances of having another baby with the condition is about a 2 in 50 (about 4 percent). You can talk to a genetic counselor to help you understand the chances of having another baby with clubfoot. A genetic counselor is a person who is trained to know about genetics, birth defects and other medical problems that run in families.
  • You have oligohydramnios during pregnancy. This is when you don’t have enough amniotic fluid. This is the fluid that surrounds your baby in the womb.
  • You have an infection or use street drugs or smoke during pregnancy. Don’t smoke or take street drugs during pregnancy.

Last reviewed January 2013

See also: Your family health history, Genetic counseling

Call your provider now if your baby

  • Has a temperature above 100.4º F
  • Has trouble breathing or is hard to waken
  • Has blood in her vomit or stool
  • Has yellowish skin or eyes
  • Is having a seizure

Frequently Asked Questions

Can dad's exposure to chemicals harm his future kids?

Dad's exposure to harmful chemicals and substances before conception or during his partner's pregnancy can affect his children. Harmful exposures can include drugs (prescription, over-the-counter and illegal drugs), alcohol, cigarettes, cigarette smoke, chemotherapy and radiation. They also include exposure to lead, mercury and pesticides.

Unlike mom's exposures, dad's exposures do not appear to cause birth defects. They can, however, damage a man's sperm quality, causing fertility problems and miscarriage. Some exposures may cause genetic changes in sperm that may increase the risk of childhood cancer. Cancer treatments, like chemotherapy and radiation, can seriously alter sperm, at least for a few months post treatment. Some men choose to bank their sperm to preserve its integrity before they receive treatment. If you have a question about a specific exposure, contact the Organization of Teratology Information Specialists at www.otispregnancy.org.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

Does cleft lip or cleft palate cause dental problems?

A cleft lip or cleft palate that extends into the upper gums (where top teeth develop) can cause your baby to have certain dental problems, including:

  • Missing teeth
  • Too many teeth
  • Oddly shaped teeth
  • Teeth that are out of position around the cleft

Every baby with a cleft lip or palate should get regular dental checkups by a dentist with experience taking care of children with oral clefts. Dental problems caused by cleft lip or palate usually can be fixed. If needed, your baby can get ongoing care by a team of experts, including:

  • A dentist
  • An orthodontist to move teeth using braces
  • An oral surgeon to reposition parts of the upper jaw, if needed, and to fix the cleft

See also: Cleft lip and cleft palate

 

Does cleft lip or cleft palate cause ear problems?

Cleft lip does not cause ear problems.

Babies with cleft palate, however, are more likely than other babies to have ear infections and, in some cases, hearing loss. This is because cleft palate can cause fluid to build up in your baby’s middle ear. The fluid can become infected and cause fever and earache. If fluid keeps building up with or without infection, it can cause mild to moderate hearing loss.

Without treatment , hearing loss can affect your baby’s language development and may become permanent.

With the right care, this kind of hearing loss is usually temporary. Your baby’s provider may recommend:

  • Having your baby’s ears checked regularly for fluid buildup
  • Medicines for treating fluid buildup and ear infections
  • Ear tubes if your baby has fluid in his ears over and over again. Ear tubes are tiny tubes that are inserted into the eardrum to drain the fluid and help prevent infections.

See also: Cleft lip and cleft palate

Does cleft lip or cleft palate cause problems with breastfeeding?

Babies with only a cleft lip usually don’t have trouble breastfeeding. Most of the time, they can breastfeed just fine. But they may need some extra time to get started.

Babies with cleft lip and palate or with isolated cleft palate can have:

  • Trouble sucking strong enough to draw milk through a nipple
  • Problems with gagging or choking
  • Problems with milk coming through the nose while feeding

Most babies with cleft palate can’t feed from the breast. If your baby has cleft palate, he can still get the health benefits of breastfeeding if you feed him breast milk from a bottle. Your provider can show you how to express (pump) milk from your breasts and store breast milk.

Your baby’s provider can help you start good breastfeeding habits right after your baby is born. She may recommend:

  • Special nipples and bottles that can make feeding breast milk from a bottle easier
  • An obturator. This is a small plastic plate that fits into the roof of your baby’s mouth and covers the cleft opening during feeding.

See also: Cleft lip and cleft palate, Breastfeeding

Does cleft lip or cleft palate cause speech problems?

Children with cleft lip generally have normal speech. Children with cleft lip and palate or isolated cleft palate may:

  • Develop speech more slowly
  • Have a nasal sound when speaking
  • Have trouble making certain sounds

Most children can develop normal speech after having cleft palate repair. However, some children may need speech therapy to help develop normal speech.

See also: Cleft lip and cleft palate

What are choroid plexus cysts?

The choroid plexus is the area of the brain that produces the fluid that surrounds the brain and spinal cord. This is not an area of the brain that involves learning or thinking. Occasionally, one or more cysts can form in the choroid plexus. These cysts are made of blood vessels and tissue. They do not cause intellectual disabilities or learning problems. Using ultrasound, a health care provider can see these cysts in about 1 in 120 pregnancies at 15 to 20 weeks gestation. Most disappear during pregnancy or within several months after birth and are no risk to the baby. They aren't a problem by themselves. But if screening tests show other signs of risk, they may indicate a possible genetic defect. In this case, testing with higher-level ultrasound and/or amniocentesis may be recommended to confirm or rule out serious problems.

What if I didn't take folic acid before pregnancy?

If you didn’t take folic acid before getting pregnant, it doesn't necessarily mean that your baby will be born with birth defects. If women of childbearing age take 400 micrograms of folic acid every day before and during early pregnancy, it may help reduce their baby’s risk for birth defects of the brain and spin called neural tube defects (NTDs). But it only works if you take it before getting pregnant and during the first few weeks of pregnancy, often before you may even know you’re pregnant.

Because nearly half of all pregnancies in the United States are unplanned, it's important that all women of childbearing age (even if they're not trying to get pregnant) get at least 400 micrograms of folic acid every day. Take a multivitamin with folic acid before pregnancy. During pregnancy, switch to a prenatal vitamin, which should have 600 micrograms of folic acid.

Last reviewed November 2012

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