See also: Cleft lip 
What is a cleft palate?
A cleft palate occurs when the two sides of the palate (palatal shelves) fail to grow together and fuse during fetal development. Cleft palate occurs in approximately 1 in 750 live births. A cleft may result from a family history (genetic predisposition), a spontaneous change (mutation) of a gene in the case of a syndromic cleft, or exposure to some medication, chemical or infection prenatally. Most often, the cause is never determined and is identified as an isolated incidence.
The palate is divided into two sections. The first section is the hard palate (primary palate). It is located in the front of the mouth behind the front teeth and contains bone. The second section of the palate is called the soft palate or secondary palate. The soft palate is made up of muscle. A cleft palate may be complete and involve both the hard and soft palate or it may be incomplete and only affect a portion of the palate.
Cleft lip vs. cleft palate
Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.
Veau Classifications of Clefts
Class I: Incomplete cleft involving only the soft palate
Class II: Cleft involving the hard and soft palate
Class III: Complete unilateral cleft involving the lip and palate
Class IV: Complete bilateral cleft
Cleft palate characteristics
Children may have a cleft of the soft palate or both the hard palate and soft palate. A cleft can occur on one side (unilateral) or both sides (bilateral).
Diagnosis of cleft palate
Although a cleft lip can be detected during routine prenatal ultrasound, a cleft of the palate may not be diagnosed until after birth.
Prenatal consultation with the Inova Children's Craniofacial Program nurse manager and/or plastic and reconstructive surgeon (craniofacial surgeon) offers expecting parents a unique opportunity to learn about their infant’s condition and feel well prepared for his or her birth. It is also a good time to reassure parents that they did not do anything to cause the cleft.
Contact us
Please call 703-776-6920 to schedule a prenatal consultation with the Inova Children's Hospital Craniofacial Program nurse manager.
Feeding techniques for a baby with a cleft palate
Before surgery, your baby will feed using special bottles and nipples. Available feeding systems include:
An opening in the palate makes it very difficult for the infant to get the suction he/she needs to breast feed efficiently. These special bottles help compensate for the lack of suction, improve feeding and ensure infants gain weight well.
Breast feeding can be an option in infants with cleft lip only, or when there is a very small palatal cleft. In most cases however, breast feeding alone will not provide a sufficient amount of milk necessary for baby to maintain nutrition and gain weight. The Inova Craniofacial Team recommends using one of the cleft palate bottles. The team's speech pathologist (feeding expert) will help parents determine the right bottle and nipple for their baby.
Parents are encouraged to experiment with and use whatever method seems to be preferred by their baby and is easiest and most comfortable for them. Parents may decide to use formula or pump breast milk for feeding. Feeding may seem to be bit challenging at first, but with patience and experience it should become routine.
Important nutrition signs for parents of a baby with cleft palate
We recommend that parents do the following:
- Keep track of the number of wet diapers baby has per day to ensure the baby is getting enough milk. Six to eight wet diapers a day on average is expected.
- Take the baby to the pediatrician's office for weekly weight checks to ensure adequate weight gain. Discuss with the pediatrician expected weight gain per week.
- Typically a healthy full-term newborn slowly increases intake to 2-3 ounces of breast milk or formula per pound of body weight per day.
- The feeding should be completed in 30 minutes or less. An infant who feeds longer then this is working very hard and burning the calories that he or she needs for adequate weight gain.
Nursing problems and solutions for babies with cleft palate
- Sit up: Sit the baby in a more upright position; this will help reduce nasal regurgitation (milk coming out of nose).
- Clear nasal regurgitation: If nasal regurgitation occurs, the feeding should stop; allow him or her to cough or sneeze to clear the nasal airway. Gently wipe the nose with a moist cloth.
- Burp frequently: Baby should be burped frequently to eliminate any air in the tummy that may make baby feel full.
- Angle the nipple: If possible, angle the nipple away from the cleft to help baby squeeze the nipple between his or her tongue and an intact portion of the palate.
Free cleft palate feeding videos and resources
Watch a series of free "Feeding Your Baby" videos and download other free material from cleftline.org, the website of the American Cleft Palate-Craniofacial Association.
Cleft palate repair surgery
Cleft palate repair is generally scheduled between 6-12 months of age. The surgeon will discuss timing of palate closure with parents. The palate provides a barrier between the oral and nasal cavities and plays a very important role in feeding and speech development. The purpose of cleft palate repair is to restore normal function.
Parents should practice using a sippy cup for feeding prior to surgery. The surgeon may recommend that the baby use a different feeding method for approximately 2 weeks post-surgery. Getting the baby acquainted with feeding from the sippy cup in advance can help reduce feeding challenges postoperatively.
The surgery will take place at Inova Children’s Hospital. It takes approximately 2.5 hours to perform a palate repair. Hospital stay is at least one night so the staff can monitor baby’s comfort level, hydration status and airway.
Cleft palate repair post-op instructions
- Be careful: No hard or sharp objects are allowed for several weeks postoperatively. It is very important to avoid anything that could potentially injure the palate or damage the sutures.
- Restrain elbows: Elbow restraints ("no-nos") are used to keep the baby’s hands away from his or her mouth. No-nos may be removed during bathing, but should be left in place much of the time for the first 3 weeks.
- Suture absorbtion: The sutures used to close the palate are absorbable. Parents should schedule a post-operative appointment with their surgeon 14-21 days post-surgery.
- Follow-up appointment: Schedule a team appointment 6 months after the palate repair by calling 703-776-6920.
What to feed your baby after cleft palate repair surgery
The first day after surgery, an IV will provide the baby with fluids until he or she is ready to begin feeding again. Before discharge, the nurses will demonstrate how to feed the baby. Plan to use a sippy cup for approximately two weeks. You may slowly add soft pureed foods (baby foods) to the baby's diet, but avoid sticky foods like peanut butter. It is important to avoid all hard and/or crunchy foods while the cleft palate surgery site is healing.