Introduction
At the beginning of pregnancy, parts of the baby’s face develop independently, only gradually joining together. If they do not connect properly as they should, a child with a cleft lip or palate will be born.
The cleft lip can be just an inconspicuous dent in the reddish area of the upper lip, or a complete cleft of lip and nose. A cleft palate is a gap in a hard or soft palate (the roof of the mouth). Both defects can occur together or separately. A cleft lip can affect one side of the face (unilateral) or both sides (bilateral).
If you learned during your visit at the gynecologist that you are expecting a baby with a cleft or your baby has already been born, you are full of emotions and you certainly have many questions. You can get answers in our prenatal clinic of the Cleft Center Prague. A specialist from the cleft team will listen to you. Contact us as soon as possible so that treatment can begin immediately.
A common question is whether cleft lip and palate are associated with the delayed child development or mental retardation. Mental retardation and delayed development occur in only 15% of children with clefts. At 85% it stands for only a cleft defect. In most cases, even with surgical procedures and repeated visits to the doctor, a child with cleft develops and grows happily as any other child.
Another parent question is, how did this happen? There is no simple cause of developing cleft. In most cases, it is a combination of various genetic or environmental factors. They cannot be determined or detected in advance. But it is unlikely that the cleft occurred because you did something wrong or did not. Worldwide, 1 child is born with a cleft to 700 newborns, and this number has not changed for several decades.
Speech
Cleft defects of the face are very often accompanied by disorders of speech, hearing and voice. The reason for this is a complex disorder of the orofacial complex. In children, where the cleft affects only the lip and the palate is not affected, there are no problems with speech development.
In other cases, children are sometimes faced with poor articulation, because when making sounds, a cleft defect leads to incorrect articulation stereotypes. The resonant component of speech may also be violated due to insufficient function of the soft palate. The oral cavity and the nose cavity are not sufficiently separated, and this creates the so-called open mumbling. The voice may also have other defects: increased nasality, hyperrhinophony, or hoarseness, dysphonia.
Speech development in a child with a cleft defect may be delayed for various reasons. However, the cleft defect itself does not directly cause a delay in speech development. It is affected by hearing disorders or orthodontic disorders. About half of children with a cleft palate need the care of a speech therapist.
Despite various difficulties with speech, voice or hearing, your baby needs to hear speech and see the movements of the lips and tongue before he or she starts copying the adult. Parents are for the baby the main persons who can contribute to the proper development of speech. From the infancy period there is a need to pay attention to the child, to speak to him or her directly, so that he or she can see the movement of the mouth and hear the subsequent sound. Sounds need to be repeated often, not too loudly. It is recommended to blow into the bubble, read children’s books, imitate the sounds of animals, or use simple sounds.
Dental care
Tooth decay occurs more in children with cleft lip and/or palate than in other children. It is not known exactly why. The most likely explanation is that the teeth are close together and harder to clean.Increased cariosity can also be caused by bacterias in the oral cavity. Therefore, it is important to be careful with food and learn to brush your teeth regularly and correctly. The child should have a dentist from an early age – tooth decay can occur already at two or three years of age.
Also, the dental hygienist will give you advice on all options for improving oral hygiene, including brushing your teeth and using products to help keep them healthy and clean during cleft treatment.
Feeding
An essential part of the activity of the cleft team is cooperation with a wide range of people who care for your baby at the time of finding the optimal way of feeding. During normal milk sucking, the baby grasps the mother’s nipple or feeding bottle with his or her lips and pumps the milk with the force of the tongue and pressure. Babies with cleft lip usually do not have a problem with sucking, some only have trouble firmly grasping the nipple or feeding bottle. However, children with the cleft palate usually fail to create enough pressure in the oral cavity for suction because the cleft causes air leak. Therefore, they need help with feeding. A nurse from the cleft team will advise the mothers and show a demonstration to guide them on how to feed their baby.
Psychology
Many children with cleft lip have no psychological problem or worry that would result from their defect. However, parents are often worried about how their child will develop and what problems he or she will face in the future.
At each stage of your child’s development, you and your child could use help from a psychologist. You will learn how best to support the child during treatment. Some parents are also not sure how to tell other people about the cleft and how to talk about the cleft with their child. Others fear possible ridicule at school time. The cleft team psychologist is always available to discuss any concerns with you.
Surgery
The solution to cleft defects is surgical interventions involving suturing muscles and other tissues that did not connect in the womb during the development of the baby. Recent studies show that not every cleft lip is suitable for early surgical treatment immediately after birth. Most children with cleft lip and palate benefit from the fact that the jaw and nose tissues grow and thicken during the time.
There are many different surgery procedures of cleft lip and palate. You will learn about them during the examination. Experts from the cleft team will advise you when it is appropriate to perform the operation and arrange it for each one child. Since every child develops individually, the need for surgery and its timing may be different.