A cleft is a gap or split in a body structure that didn’t fully close during development. In most contexts, the term refers to a cleft lip, a cleft palate, or both, which are among the most common birth defects. In the United States, about 1 in 1,031 babies is born with a cleft lip (with or without a cleft palate), and about 1 in 1,563 is born with a cleft palate alone. These conditions are treatable, and most children go on to live completely normal lives after a series of surgeries and supportive care during childhood.
Cleft Lip vs. Cleft Palate
A cleft lip is a partial or complete split in the upper lip. It can appear on one side (unilateral) or both sides (bilateral). Left-sided cleft lips are more common than right-sided ones, and unilateral clefts are far more common than bilateral ones. The split can be small, barely reaching the nose, or it can extend through the gum line.
A cleft palate is a gap in the roof of the mouth. It can involve just the soft palate (the fleshy area toward the back of the mouth) or both the hard and soft palate. The opening can be narrow and V-shaped or wider and U-shaped. With a cleft palate alone, the lip looks completely normal.
When both occur together, the split runs from the upper lip through the gum and into the palate. This combined form, cleft lip with cleft palate, is its own category and typically requires the most extensive treatment.
How a Cleft Forms
During early pregnancy, a baby’s face develops from separate tissue segments that grow toward each other and fuse together. The upper lip normally closes first, and then the two shelves that form the roof of the mouth gradually move inward and join along the midline. This palate fusion begins around 8 weeks of development and is completed during or after 9 weeks. A cleft happens when these tissues don’t fully meet and merge.
The exact cause varies. Both genetics and environmental factors play a role, and in most cases no single cause can be pinpointed. Family history of clefting increases the risk. Certain exposures during pregnancy, including smoking, alcohol, and some medications, have been linked to higher rates. The interplay between a baby’s genetic makeup and what happens in the womb during those critical early weeks of facial development determines whether a cleft forms.
Feeding Challenges in Newborns
Babies with cleft palates often struggle to feed because they can’t create the suction needed to draw milk from a breast or standard bottle. They tend to have shorter sucks, a faster sucking rate, and difficulty generating the negative pressure inside the mouth that makes feeding work. The success rate of breastfeeding a baby with a cleft palate is around 10%.
Specialized bottles solve this problem by delivering milk even when a baby can’t latch or suck effectively. The most widely used options include the Pigeon Cleft Palate Soft Bottle and the Medela Special Needs Feeder, both designed to let a caregiver gently squeeze milk into the baby’s mouth at a controlled pace. A feeding specialist typically works with families in the first days after birth to find the right approach, and most babies gain weight normally once the right equipment is in place.
Effects on Hearing
Cleft palate almost universally affects the tube that connects the middle ear to the back of the throat. This tube normally opens and closes to equalize pressure and drain fluid from the ear. In children with cleft palates, the muscles that control it don’t work properly, so fluid builds up in the middle ear and muffles sound.
Before treatment, about 67% of ears in children with cleft palates show abnormal hearing thresholds. Small tubes placed in the eardrums to drain fluid drop that number to just 7.5%. After the palate is surgically repaired, the tube function gradually recovers on its own, and more than 90% of ears eventually maintain normal hearing. That recovery can take years, though, which is why ear tubes and regular hearing checks are a standard part of cleft care throughout childhood.
Effects on Speech
The palate plays a central role in speech. When you make sounds like “p,” “b,” or “t,” the soft palate lifts to seal off the nasal cavity and direct air through your mouth. A cleft palate, even after repair, can leave this seal incomplete. The result is hypernasality: too much sound resonating through the nose, giving speech a distinctive quality. Air may also leak audibly through the nose during consonants that require pressure buildup in the mouth.
Children with repaired clefts sometimes develop compensatory habits, producing sounds in the back of the throat instead of at the lips or tongue tip. Speech therapy, often starting around age two or three, focuses on correcting the placement of these sounds. Therapists typically begin with lip sounds like “p” and “b,” then work toward tongue-tip sounds and sounds made at the back of the mouth. Some children need additional surgery to improve the seal between the mouth and nose before speech therapy alone can be effective.
Surgical Repair Timeline
Cleft lip repair is generally performed when a baby is 3 to 5 months old. The surgeon closes the gap in the lip, aligning the skin, muscle, and tissue to restore both function and appearance. Cleft palate repair follows later, typically between 10 and 14 months, timed around the child’s development and airway size.
These initial surgeries are rarely the end of treatment. As the face grows, many children need additional procedures. Bone grafting to fill a gap in the gum line usually happens around age 8 to 10. Orthodontic work to align the teeth is common throughout adolescence. Some teens or young adults choose a nose revision once facial growth is complete. The specific path depends on the type and severity of the original cleft.
The Long-Term Care Team
Cleft care spans from birth into early adulthood, and no single specialist can cover everything. Children are followed by a craniofacial team that typically includes a plastic or oral surgeon, an orthodontist, a speech therapist, an ear-nose-and-throat specialist, a feeding specialist, a dentist, and a nurse coordinator who keeps all the moving pieces organized. A geneticist may also be involved to evaluate whether the cleft is part of a broader genetic condition.
The family is considered part of this team. Appointments are usually consolidated so that a child can see multiple specialists in a single visit rather than bouncing between offices throughout the month. Social workers on the team help navigate insurance coverage and connect families with support networks. This coordinated model exists because the needs of a child with a cleft shift over time: feeding support gives way to speech therapy, which overlaps with dental care, which leads into orthodontics and sometimes later surgeries. Each phase builds on the last.