What is a cleft?
A cleft is a gap or split in the upper lip and/or roof of the mouth (palate). A cleft lip or palate occurs when the structures that form the upper lip or palate do not join together when a baby is developing in the womb. The causes of cleft are complicated, and they are usually the result of different factors coming together in a way that couldn’t be predicted or prevented. A cleft is very unlikely to be the result of anything a mother did or did not do during pregnancy.
A cleft may affect the lip only, the palate only, or may affect the lip and the palate. Sometimes a cleft palate can be hidden by the lining of the roof of the mouth, this is called a submucous cleft palate. Sometimes a cleft can be part of a syndrome, which is when lots of different symptoms happen together.
Most children treated for cleft lip and/or palate grow up to live completely normal lives. Treatment can normally improve the appearance of the face and resolve difficulties with feeding and speech.
How is a cleft diagnosed?
Cleft lip and/or palate is usually identified at the 20-week anomaly scan, immediately after birth or during the newborn physical examination. However, sometimes clefts are not identified until later. A submucous cleft palate can be harder to see, so may not be identified until a child is a bit older.
When a cleft lip or palate is diagnosed, the child will be referred to a specialist NHS cleft team who will support the child and family throughout childhood. These specialist cleft teams provide a range of different services throughout childhood and adolescence to support people with a cleft.
Children within Kent are usually known to the South Thames Cleft Service.
Strategies and approaches
If your child is receiving therapy for a specific area of need (e.g. their speech sounds or language development), please have a look at the videos in the relevant area of our website.
Useful websites
More information can be found on the following websites:
Cleft Lip and Palate Association
This website provides advice and support for people with the condition, their families and school staff.
NHS Conditions
Information about cleft lip and palate.
Velopharyngeal Dysfunction
Some children do not have a cleft palate, but their soft palate may not close with their back of their throat properly which means that air can escape through their nose. This is called velopharyngeal dysfunction. These children are also seen by a specialist NHS cleft team.
Things you may notice
Things you may notice if your child has a cleft palate, submucous cleft palate or velopharyngeal dysfunction:
- Your child may have difficulties with feeding and meal times may take longer than usual.
- Food and drink may come down your child’s nose when they are eating and drinking.
- Your child may have hearing difficulties or glue ear.
- Your child may sound like they have too much air coming down their nose. Your child’s speech may have a nasal tone, or puffs of air may be coming down their nose when they are talking.
- Your child may have developed unusual patterns in their speech – for example using lots of nasal sounds (e.g. m, n) or they may make sounds right at the back of their mouth (e.g. h, or a glottal stop sound).
Referral
The SLT service supports children who have a cleft palate or velopharyngeal dysfunction if they have additional difficulties with their speech, language and communication skills (based on service criteria). We work closely with the South Thames Cleft Service to support children with cleft or velopharyngeal dysfunction who are known to our service.
Some children with a cleft or velopharyngeal dysfunction will need extra help to develop their speech sounds. These children may be referred to KCHFT by the Cleft Services, so that we can offer some extra help. If you are concerned about your child’s speech sounds, please discuss this with the Speech and Language Therapist within your child’s cleft team and they can make a referral to us if this is needed. It may be useful to access the speech sounds area of our website.
Sometimes, children with a cleft may have difficulties with other aspects of their speech, language and communication skills, for example with their language, voice or social communication skills. If you are concerned about an area of your child’s speech, language or communication, please discuss this with the Speech and Language Therapist within your child’s cleft team and they can make a referral to us if this is needed.
If you are concerned that your child may have a cleft or velopharyngeal dysfunction that has not previously been identified, please complete our online referral form by following the link below or contact your local team to discuss your concerns. If your child is at nursery or school, you may also find it helpful to discuss your concerns with them and agree together whether a referral is needed. If we find that your child is presenting with signs of a cleft or velopharyngeal dysfunction, then we will make a referral to the South Thames Cleft Service.