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The fourth most common birth defect in the United States: Cleft lip and cleft palate. One in every 700 babies born have a cleft lip and/or cleft palate (Cleft lip and cleft palate, 2017). Children with Native American, Latino, or Asian ancestry are more likely to be born with clefts. “Compared with girls, twice as many boys have a cleft lip, both with and without a cleft palate. However, compared with boys, twice as many girls have cleft palate without a cleft lip” (Cleft lip and cleft palate, 2005-2017, p. 1). What is cleft lip and cleft palate?
A cleft is a separation or split (Cleft lip and cleft palate, 2017). An orofacial cleft is an opening in the roof of the mouth and/or lip. All clefts are treatable. Most children have surgery very early in life to get them fixed (Cleft lip and palate, 1995-2018). A cleft lip is a tear in the upper lip between the nose and mouth. A cleft on one side is known as a unilateral cleft, while a cleft on both sides is known as a bilateral cleft. A cleft palate is a tear in the roof of the mouth. The back of the palate more towards your throat is called the soft palate whereas the front of the palate towards your mouth is called the hard palate (Cleft lip and cleft palate, 2017). These facial and oral malformations occur very early on in pregnancy when the baby is developing in the mother. It is possible to have one without the other or to have both a cleft lip and a cleft palate (Cleft lip and cleft palate, 2005-2017).
Clefts form within the first ten weeks of pregnancy. The bones and tissues of a baby’s mouth, nose, and upper jaw would normally fuse together to form the upper lip and the roof of the mouth, but instead the tissue does not come together and a cleft forms. A cleft lip may look like a slight opening just above the lip, but it can also extend to the nose and even the gums. A cleft palate can range from small to large. A cleft lip by itself is most common in boys, while a cleft palate by itself is most common in girls. Both cleft lip and palate together are more common in boys. Some cleft lips are seen on prenatal ultrasounds, while others can only be seen when the child is born. A cleft palate is tough to discern until the mouth is inspected after birth (Cleft lip and palate, 1995-2018).
Many clefts are thought to be a combination of environmental and genetic factors. Mothers and fathers can both pass on genes that cause cleft lip and/or cleft palate. If mothers take certain medications during pregnancy they can increase the chances of their baby having a cleft lip or palate. Mothers who do not get the right amount of prenatal nutrients can also increase the chance of their baby having a cleft. Another possible cause of cleft lip and cleft palate is when women smoke cigarettes, use drugs, or drink alcohol during pregnancy. “Research has shown that moms who binge drink (drinking four or more drinks in a short period of time) during the first weeks of pregnancy have a higher risk of having a baby with a facial birth defect like a cleft lip or cleft palate” (Cleft lip and palate, 1995-2018, p.1). Cleft lip and cleft palate cannot be prevented (Cleft lip and cleft palate, 2005-2017). Another factor is the number of people in the family affected and the closeness of the relatives that had or have a cleft. Sometimes babies will be born with a cleft with no one in the family having one, and other times clefts may run in families (Cleft lip and cleft palate, 2017). Other health problems caused by clefts.
Kids with clefts sometimes have different problems caused by their cleft/clefts. Some of the problems are feeding problems, hearing loss, dental problems, and speech problems. A normal palate prevents food and drink from entering the nose. “A cleft palate causes babies to swallow a lot of air and regurgitate food into the nose” (Cleft lip and palate, 1995-2018, p. 1). Children with a cleft palate have the option of wearing a man-made palate to help them eat properly until surgical treatment is provided (Cleft lip and cleft palate, 2005-2017). Those with cleft palate suffer from fluid buildup in the middle ear. This can lead to ear infections and often hearing loss. Many children with cleft palate need ear tubes put into their eardrums to help drain the fluid and enhance hearing (Cleft lip and palate, 1995-2018). Children with cleft palate need to have their hearing checked at least once a year (Cleft lip and cleft palate, 2005-2017). Those with cleft lip or cleft palate may also have dental problems such as small teeth, missing teeth, or extra teeth. Their teeth may be out of position as well. They may have an infirmity in the gums or alveolar ridge. Ridge defects can rotate, tip, or displace permanent teeth or prevent them from coming in properly (Cleft lip and palate, 1995-2018). Those with clefts are more prone to cavities than those without clefts (Cleft lip and cleft palate, 2005-2017). Children with cleft palate have more speech problems than children with cleft lip. One in five kids with cleft palate still have speech problems even after surgical repair. This means the child’s voice is hypernasal. This occurs because the palate does not move well enough to stop air from coming out of the nose (Cleft lip and palate, 1995-2018). How are clefts treated?
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