The presentation can vary widely:

Small Notch in the Upper Lip

 Some children may have only a minor indentation or notch in the upper lip.

Complete Cleft of the Lip and Alveolus

 Others may have a full cleft that extends through the lip and into the gum line (alveolus).

Initial Consultation

 It is recommended to see the child within a week after birth, especially if the child has a cleft of both the lip and palate. Early intervention is crucial for the following reasons

Nasoalveolar Molding (NAM)

 For children with both a cleft lip and palate, NAM treatment can be started early. NAM involves the use of an acrylic plate to reshape the gums, lip, and nose before lip surgery. This process reduces tension during the lip closure surgery, leading to better surgical outcomes. Additionally, the acrylic plate helps with feeding by blocking the cleft in the palate, making it easier for the baby to feed. NAM is not required for babies who have a cleft of the palate alone or an incomplete cleft of the lip.

 Feeding a baby with a cleft palate requires special techniques due to the challenges in creating suction and the potential for milk to leak through the nose. Immediately after birth, the baby should be placed at the mother's breast to encourage bonding and initiate feeding. However, many babies with a cleft palate may struggle to breastfeed directly because they cannot create the necessary suction.

 Milk leakage through the nose during feeding can be alarming for new mothers, but it is a common occurrence with cleft palate. At this stage, it is essential for the mother to receive guidance from a lactation consultant. The consultant can teach proper feeding techniques that accommodate the baby's needs, such as using specialized bottles or positioning strategies, to ensure that the baby receives adequate nutrition.

 The goal is to ensure that the baby gets exclusive breast milk for at least the first six months of life, as breast milk provides essential nutrients and immune protection that are critical for the baby's development, especially in the context of a cleft palate. With the right support and techniques, mothers can successfully feed their babies and provide them with the best possible start in life.

 By addressing the cleft early, particularly with NAM, the overall surgical process and the child's development can be significantly improved.

 Here's a table summarizing the various surgical procedures for cleft lip and palate treatment, along with the appropriate age for each procedure:

 This table provides a general guideline, but the specific timing and necessity of each procedure can vary based on the individual needs of the child and the recommendations of the medical team.

Nutrition Support

 Babies born with clefts face the risk of malnutrition, even when food supply is abundant. This is because clefts affect their ability to suck often making it very difficult to breast feed or even bottle feed

 Without proper feeding and nutrition support, many cleft babies die from malnutrition. Early diagnosis and nutrition support can help babies born with cleft receive timely surgery and associated comprehensive care, enabling them to live full and productive lives

 At the first intervention, our nutrition specialist provides counselling and feeding support for cleft children to enable them to have a safe surgery. As babies born with clefts, especially cleft palate have difficulty on breastfeeding our professionals train mothers and care givers in effective breastfeeding technique. Counselling is also provided on the correct positioning of the baby for feeding whether directly or with feeding devices. Mothers are discouraged from using the feeding bottle but rather educated on using feeding devices such as paladai, spoon, nifty cups etc. Counselling is also provided on weaning and complementary feeding thereby making the transition from mother’s milk to regular food easy.

 Every child’s growth is monitored on a regular basis and advice given as per the child’s requirement respective of their age and development. In case of any delay in child’s growth and development, the child is reviewed by our pediatricians for better outcomes.

 Mother’s health status is also equally important when feeding. A malnourished mother will not have adequate breast milk to feed her child and this is given importance too. The mother is also assessed and counselled accordingly to ensure overall success of the nutrition program.

Speech Therapy

 Communication skills, is one among the main challenges faced by a patient with cleft of the lip and/or palate. It is a common myth that these children will have developmental language delay. It is important to note that they will have a normal language development, provided the child is given adequate stimulation at home.

 The role of a Speech Language Pathologist (SLP) begins as soon as the palate repair is completed by 10-12 months of age. The parents/care givers of the children are given a detailed counselling by SLP regarding language stimulation techniques enabling the child to begin verbal communication without any delay. This is then followed up by regular hospital visits and constant tracking of the child's development. By 3 years of age, as the child attains phrase to sentence level of communication, detailed Speech evaluation is conducted with different language specific test materials, to identify and map compensatory articulation or speech sound placement errors the child may have developed due to structural or functional changes. Regular Speech therapy sessions and assessments, which include both perceptual and instrumental (Naso endoscopy, Videofluoroscopy) evaluation help us to bring the child closer to a near normal communication ability.

  As the child grows older, we also check for further structural abnormalities, like Velopharyngeal Dysfunction (short soft palate) which causes the child to have abnormal nasality and an emission of air from the nostrils during speech. This reduces the intelligibility of their speech. With the help of a series of assessments, therapy sessions and instrumental evaluation the Speech Language Pathologist, is able to identify if a surgical intervention is necessary.

 The Speech Language Pathologist travels with each patient throughout their childhood onto their adulthood until their communication skills are competent to the outside world.