Treatment

Children with a cleft lip or palate may need several treatments and assessments as they grow up. The cleft is usually treated with surgery. Other treatments, such asspeech therapy or dental care, may be needed for associated symptoms. Your child will be cared for bya specialist multidisciplinarycleft team within an NHS cleft centre. This page covers: Your child's care plan Surgery Feeding help and advice Treating hearing problems Dental care Speech and language therapy Specialist cleft centres Your child's care plan Children with clefts will have a care plan tailored to meet their individual needs. A typical care plan timetable for cleft lip and palateis described below: birth to six weeks feeding assistance, support for parents, hearing tests andpaediatric assessment 3-6 months surgery to repaira cleft lip 6-12 months surgery to repair a cleft palate 18 months speech assessment three years speech assessment five years speech assessment 8-12 years bone graft toa cleft in the gum area 12-15 yearsorthodontic treatment and monitoring jaw growth Your child will also need to attend regular outpatient appointments at the cleft clinic sotheir condition can be monitored closely and any problems can be dealt with. These will usually be recommended until they're around 21 years of age, when they're likely to have stopped growing. Surgery Lip repair surgery Lip repair surgery is usually carried out when your child is around three months old. Your child will be given a general anaesthetic (where they're asleep) and the cleft lip carefully repaired and closed with stitches. The operation usually takes one to two hours. Most children are in hospital for a day or two. Arrangements may be made for you to stay with them during this time. The stitches are removed after a few days or may dissolve on their own depending on the type of stitches used. Your child will have a slight scar, but the surgeon will attempt to line up the scar with the natural lines of the lip to make it less noticeable. It should fade and become less obvious over time.. Palate repair surgery Palate repair surgery is usually carried out when your child is6-12 months old. The gap in the roof of the mouth is closed and the muscles and the lining of the palate are rearranged. The wound is closed with dissolvable stitches. The operation usually takes about two hours and is carried out under general anaesthetic. Most children are in hospital for one to three days, and again arrangements may be made for you to stay with them. The scar from palate repair will be inside the mouth. Additional surgery In some cases, additional surgery may becarried outat a later stage to: repair a cleft in the gum using a piece of bone(bone graft) usually done at around 8-12 years of age improve the appearance and function of the lips and palate this may be necessary if the original surgery doesn'theal well orthere are any ongoing speech problems improve the shape of the nose ( rhinoplasty ) improve the appearance of the jawsome children born with a cleft lip or palate mayhave asmall or "set-back" lower jaw Feeding help and advice Many babies with a cleft palate have problems breastfeeding because of the gap in the roof of their mouth. They may struggle to form a seal with their mouth so they may take in a lot of air and milk may come out of their nose. They may alsostruggle to put on weight during their first few months. Aspecialist cleft nurse can advise onpositioning, alternative feeding methods and weaning if necessary. If breastfeeding isn't possible, they may suggest expressing your breast milk into a flexible bottle that is specially designed for babies with a cleft palate. Very occasionally, it may be necessary for your baby to be fed through a tubeplaced into their nose until surgery is carried out. Treating hearing problems Children with a cleft palate are more likely to develop a condition called Otitis media with effusion (OME) , where fluid builds up in the ear. This is because the muscles in the palate are connected to the middle ear. Ifthe muscles aren't working properly because of the cleft, sticky secretions may build up within the middle earand may reduce hearing. Your child will have regular hearing tests to check for any issues. Hearing problems may improve after cleft palate repair and, if necessary, can be treated by insertingtiny plastic tubes called grommets into the eardrums. These allow the fluid to drain from the ear. Sometimes, hearing aids may be recommended. Often a tooth may be missing, or there may be an extra tooth. A paediatric dentist will monitor the health of your child's teeth and recommend treatment when necessary. It's also important that you register your child with a family dentist. Orthodontic treatment , which helps improve the alignment and appearance of teeth, may also be required. This can include using braces or other dental appliances to help straighten the teeth. Brace treatment usually starts after all the baby teeth are lost, but may be necessary before the bone graft, to repair the cleft of the gum. Children with a cleft are more vulnerable to tooth decay , so it's important to encourage them to practise good oral hygiene and to visit their dentist regularly. Speech and language therapy Repairing a cleft palate will significantly reduce the chance of future speech problems, but in some cases, children with a repaired cleft palate still need some form of speech therapy. A speech and language therapist (SLT) will carry out several assessments of your child's speech as they get older. If there are any problems, they may recommend further assessment of how the palate is working and/or work with you to help your child develop clear speech. They may refer you to community SLT services nearer to your home. The SLT will continue to monitor your child's speech until they are fully grown and they will work with your child for as long as they need assistance. Further corrective surgery maysometimes berequired for a small number of children who have increasedairflow through their nose when they're speaking, resulting in nasal-sounding speech. Specialist UK cleft lip and palate sites England Royal Victoria Infirmary, Newcastle-upon-Tyne Leeds General Infirmary Royal Manchester Children's Hospital Alder Hey Children's Hospital, Liverpool NottinghamChildren's Hospital Birmingham Children's Hospital Addenbrooke's Hospital, Cambridge Great Ormond Street Hospital, London Broomfield Hospital, Chelmsford John Radcliffe Hospital, Oxford Salisbury District Hospital Bristol Royal Hospital for Children Guy's and St Thomas' Hospital, London Wales Morriston Hospital, Swansea Scotland Royal Hospital for Sick Children, Edinburgh Royal Hospital for Sick Children, Glasgow Northern Ireland Children's Hospital, Belfast