Baby Born with Cleft Lip or Palate
The short answer
Cleft lip and cleft palate are among the most common birth differences, occurring in about 1 in 1,600 births. A cleft lip is an opening in the upper lip, while a cleft palate is an opening in the roof of the mouth. They can occur alone or together. With modern surgical repair and a supportive care team, most children with clefts go on to eat, speak, and develop normally. Surgical repair is typically done in the first year of life.
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By Age
What to expect by age
Newborn
A cleft lip is visible at birth and is usually detected during delivery or on prenatal ultrasound. A cleft palate may not be immediately visible and is sometimes discovered when feeding difficulties arise. The immediate priority is establishing feeding, as babies with cleft palate often cannot create the suction needed for breastfeeding or standard bottle feeding. Specialized bottles (like the Pigeon or Dr. Brown's Specialty Feeding System) can help. A cleft team referral is typically made within the first days of life.
0-6 months
Cleft lip repair surgery is usually performed between 3-6 months of age. Before surgery, the focus is on weight gain and feeding support. Some babies may use a nasoalveolar molding (NAM) device to help shape the lip and nose before surgery. Breastfeeding may be possible with a cleft lip alone, but cleft palate usually requires specialized feeding techniques. Ear infections are more common in babies with cleft palate, so hearing will be monitored.
6-18 months
Cleft palate repair surgery is typically done between 9-14 months of age, before speech begins developing. After palate repair, feeding transitions to normal bottles and cups. Speech therapy evaluation usually begins around 12-18 months. Most children develop normal or near-normal speech with appropriate support. Additional surgeries may be needed as the child grows, but the major repairs happen in the first year.
What Should You Do?
When to take action
- Difficulty with feeding in the early weeks before specialized bottles are provided
- Milk coming out of the nose during feeding before palate repair
- A wide or obvious gap in the lip or palate at birth
- Needing specialized feeding equipment like squeezable bottles
- A visible scar after cleft lip repair that fades over time
- Your baby is not gaining weight despite using specialized feeding techniques
- Your baby has frequent ear infections or fluid buildup in the ears
- You have questions about surgical timing, feeding strategies, or speech development
- You want a referral to a cleft palate team if one has not been arranged
- Your baby is choking frequently during feeds or turning blue
- Your baby has a fever or signs of infection after surgery
- Your baby has significant breathing difficulty
- Your baby is not producing wet diapers or shows signs of dehydration from feeding difficulty
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Physical Concerns
I'm Worried My Baby Is Aspirating During Feeds
Aspiration means liquid or food enters the airway instead of the stomach. Occasional coughing during feeds is common and does not usually indicate aspiration. True aspiration is less common and may present as recurrent respiratory infections, a wet or gurgly voice after feeds, or chronic cough. If you are concerned, a swallow study can provide a definitive answer.
Slow Weight Gain in Breastfed Baby
Weight gain patterns vary among babies, and breastfed babies often grow differently than formula-fed babies - they tend to gain more quickly in the first three months and then more slowly from three to twelve months. This is normal and is reflected in the WHO growth charts. However, if your baby is consistently gaining less than expected or has dropped significantly on their growth curve, it is important to work with your pediatrician and possibly a lactation consultant to identify the cause and ensure your baby is getting enough milk.
Speech Delay in My Child
Speech delay means a child is developing speech and language skills in the expected order but at a slower pace than typical. It's one of the most common developmental concerns - affecting about 10-15% of toddlers - and early intervention through speech therapy is remarkably effective, with many children catching up fully by school age.
My Baby Seems to Use One Side More Than the Other
Babies should use both sides of their body fairly equally during the first 18 months of life. While slight preferences can be normal, a consistent pattern of favoring one side - using one arm much more than the other, crawling with one leg dragging, or turning the head predominantly one way - should always be discussed with your pediatrician. Early identification of asymmetry leads to the best outcomes.
My Baby Only Army Crawls
Army crawling (also called commando crawling) is a completely valid and normal way for babies to move. Many babies army crawl for weeks or even months before transitioning to hands-and-knees crawling, and some skip hands-and-knees crawling entirely. What matters is that your baby is independently mobile and exploring their environment.
One Side of My Baby's Body Moves Differently
Babies should generally use both sides of their body equally. If one side consistently moves differently, is weaker, stiffer, or less coordinated, this warrants evaluation. Asymmetric movement can indicate hemiplegia (cerebral palsy affecting one side), brachial plexus injury, or other neurological conditions that benefit from early therapy.