Cleft lip and cleft palate

What are cleft lip and cleft palate?

Cleft lip is a birth defect in which a baby’s upper lip doesn’t form completely and has an opening in it. Cleft palate is a 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 or orofacial clefts. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works.

Cleft lip and cleft palate are common birth defects. In the United States: 

• About 1 in every 1,600 babies is born with cleft lip and cleft palate
• About 1 in every 2,800 babies is born with cleft lip without cleft palate
• About 1 in every 1,700 babies is born with cleft palate

Cleft lip and cleft palate happen very early in pregnancy. Your baby’s lips form between 4 and 7 weeks of pregnancy, and the palate forms between 6 and 9 weeks of pregnancy. Oral clefts don’t have to happen together—a baby can have one without the other. Boys are twice as likely as girls to have cleft lip with or without cleft palate. Girls are more likely than boys to have cleft palate without cleft lip.

How do cleft lip and cleft palate affect a baby’s face? 

Some babies with a cleft lip have just a small notch in the upper lip. Others have a larger opening or hole in the lip that goes through the lip and up into the nose. A cleft lip can happen on one or both sides of a baby’s lip. Having a cleft in the middle of the lip is rare. 

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). In some babies with cleft palate, both the front and back parts of the palate are open. In other babies, only part of the palate is open. 

What causes cleft lip and cleft palate?

We don’t know for sure what causes cleft lip and palate. They may be caused by a combination of things, like genes and things in your environment, like what you eat or drink and medicines you take. Genes are parts of your body’s cells that store instructions for the way your body grows and works. Genes are passed from parents to children.

These things may increase your chances of having a baby with cleft lip or palate:

• Family history of cleft lip and cleft palate. Family history is health conditions and treatments that you, your partner and everyone in your families. If others in your or your partner’s family have cleft lip or cleft palate (they run in your family), you’re more likely to have a baby with these birth defects. Cleft lip and cleft palate are more common in families who are Asian, Hispanic and Native American. If you have a family history of cleft lip or palate, tell your health care provider and a genetic counselor. This is a person trained to help you understand about genes, birth defects and other medical conditions that run in families, and how they can affect your health and your baby’s health. 
• Smoking or drinking alcohol during pregnancy. Women who binge drink during the first weeks of pregnancy are more likely to have a baby with a cleft lip or cleft palate than other women. Binge drinking is when you drink four or more drinks in 2 to 3 hours. 
• Not getting enough nutrients, like folic acid, before and during pregnancy. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take folic acid before pregnancy and during early pregnancy, it can help protect your baby from cleft lip and palate and birth defects of the brain and spine called neural tube defects. 
• Having diabetes before pregnancy. Diabetes is a condition in which your body has too much sugar (called glucose) in the blood. Diabetes before pregnancy is also called preexisting diabetes or type 1 or type 2 diabetes.
• Taking certain medicines during pregnancy. If you have epilepsy and take anti-seizure medicines (like topiramate or valproic acid) during the first trimester of pregnancy, you’re more likely to have a baby with cleft lip (with or without cleft palate) than women who don’t take these medicines. Epilepsy is a seizure disorder that affects how the nerve cells in your brain work. A seizure is when the whole body or parts of the body move without control.
• Being affected by obesity during pregnancy. If you’re obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher.

What can you do to help prevent cleft lip and cleft palate in your baby?

You can’t always prevent cleft lip and cleft palate in your baby. But there are things you can do to help reduce your baby’s chances of having these birth defects: 

• Take folic acid. 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.
• Don’t smoke or drink alcohol. Alcohol includes beer, wine and liquor.
• Get a preconception checkup. This is a medical checkup you get before pregnancy to help make sure you’re healthy when you get pregnant.
• Get to a healthy weight before pregnancy and talk to your provider about gaining a healthy amount of weight during pregnancy.
• Talk to your provider to make sure any medicine you take is safe during pregnancy. You may need to stop taking a medicine or switch to one that’s safer during pregnancy. Don’t stop taking any medicine without talking to your provider first.  
• When you do get pregnant, get early and regular prenatal care. Prenatal care is medical care you get during pregnancy.

How are cleft lip and cleft palate diagnosed?

Most babies are diagnosed with cleft lip or cleft palate after birth. Some babies with certain types of cleft palate may not be diagnosed until later in life. But during pregnancy, your provider may see your baby’s cleft lip or palate in an ultrasound. Ultrasound is a prenatal test that uses sound waves and a computer screen to show a picture of your baby inside the womb. 

What problems can cleft lip and cleft palate cause for your baby? 

Babies and children with cleft lip or cleft palate may have:

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

If your baby has either, or both of these conditions, it may be more difficult to breastfeed. Babies with a cleft lip may need some extra time to get started with breastfeeding. Babies with a cleft palate have more trouble sucking and swallowing so they most likely can’t feed from the breast.  However, you can still feed your baby pumped breast milk from a bottle.

Your baby’s provider can also help start good breastfeeding habits after your baby is born.  There are special bottles that make feeding a baby with cleft palate breast milk from a bottle easier.  Your provider may also recommend a lactation consultant and other breastfeeding tips for babies with cleft lip and cleft palate.  A lactation consultant is a person that has special training to help women breastfeed. You can find a lactation consultant through your health care provider or your hospital. 

How are cleft lip and cleft palate treated?

In most cases, your baby can have surgery to repair oral clefts. Each baby is different, but it’s usually best if a baby has surgery for cleft lip before they’re 1 year old and surgery for cleft palate by the time they’re 18 months old. Surgery can help improve the look of a child’s face, and it may help with breathing, hearing and speech and language development. Many children need more surgeries for oral clefts as they grow. They also may need care from several providers, like dentists, doctors, speech therapists and surgeons who specialize in taking care of babies with problems caused by cleft lip and palate. 

With treatment, most children with clefts do well and lead a healthy life.  Providers can help babies born with birth defects like cleft lip or palate get the care they need as they grow up and over the course of their life.

More information

American Cleft Palate-Craniofacial Association

Last reviewed March 2022