Cleft lip and palate: what treatment for baby?

In France, cleft lip and palate concerns one birth in 750 per year, and cleft palates one in 2 to 000. Despite very effective medical care today, this malformation on the face, formerly called “cleft lip”, often remains a trauma for the child and those around him. However, it is the most common facial malformation in newborns.

What is a cleft lip and palate, commonly known as a cleft lip?

During pregnancy, the “facial buds” of the fetus, present from the embryonic stage, merge in a precise order, which will create the anatomical structure of the face. When some do not fuse as they should (often during the 5th to 8th embryonic week), a slit is created on the newborn’s face: his nostrils and mouth, even his palate, are not fully formed. , and communication is visible between the baby’s nose and mouth.

There are three types of cleft lip and palate: 

• la primary or labial cleft palate, when the lip and the alveolar process are affected,
• la cleft of the primary and secondary palate, or labio-palatal, when the lip, the alveolar process, but also the hard palate and the soft palate are affected
• la cleft of the secondary palate, or palate, when only the hard palate and the soft palate are affected.

In all three cases, the slits can be unilateral, symmetrical bilateral ou asymmetric bilateral, according to their presentation. This malformation is isolated in the majority of cases, but it is possible that it is related to other malformations or chromosomal abnormalities, which involves a more consequent medical management.

What Causes a Cleft Lip and Palate in Newborn Babies?

There is no single and precise cause the formation of a cleft lip and palate in babies. But certain factors can accentuate the risks, whether genetic (the risk is increased when a member of the family has already been affected, if the mother has suffered from gestational diabetes, etc.), or environmental (taking certain medications, consuming alcohol or tobacco during pregnancy…).

How to prevent the formation of a slit?

In these conditions, it is difficult to limit the risks of the formation of a cleft lip and palate in babies. Some studies recommend ensure that you follow a healthy and balanced diet during pregnancy, and to be careful about a possible vitamin deficiency, especially B9. But this advice is valid in all cases for the general health of mother and baby!

Pregnant, how do you know if your baby is affected?

The diagnosis can be made from the second trimester of pregnancy, but it is common for the cleft to go undetected until birth.

Detection of malformation on ultrasound

If the defect is detected during an ultrasound from the second trimester of pregnancy, a morphological ultrasound, and sometimes a amniocentesis, will be prescribed. Parents are then referred as far as possible for the birth to a center that has a childbirth service. pediatric maxillofacial surgery. A prenatal surgical consultation is also organized in order to clearly explain to the baby’s entourage the surgical protocol that he will have to follow. However, the announcement of the malformation is often a difficult time for parents. Priscilla, mother of Lou, now 7 years old, remembers: “ We were very affected when we learned at five months of pregnancy what to expect for our baby boy. But the time we had left before I gave birth allowed us and those around us to learn more and talk with parents who had experienced the same situation a few years earlier, as well as with adults. who were born with a cleft. All their encouragement and advice were very precious to us before and after my delivery! »

Detection at the birth of the child

If the diagnosis is only madeat birth or very shortly before, the mother and the baby will have to be hospitalized as soon as possible in a specialized center which can take care of the baby, the list of which is available here. This was the case for Aurore, mother of two boys and a little girl, Louna, 4 years old today, suffering from a bilateral cleft lip and palate: ” The diagnosis was made only sixteen days before my delivery and it therefore took place in Montluçon, which is not a specialist center in maxillofacial surgery. So I was transferred with my baby the next day to Clermont-Ferrand, where we went thereafter every eight or fifteen days for Louna’s medical appointments. ».

What medical follow-up for babies in the event of a cleft lip and palate at birth?

The diagnosis of a cleft lip and palate, also called a cleft lip, marks the onset ofa dense medical background for the baby and his parents. ” Parents often tell me that they feel like they are in the eye of the storm, in an emotional hurricane, when the diagnosis is made and the baby’s medical follow-up begins. But we must not lose sight of the fact that we are not alone and that we will be accompanied throughout the follow-up », Emphasizes Pascale Gavelle, clinical psychologist who has worked for over twenty years in the maxillofacial surgery department of the Necker Enfants Malades Hospital (Paris). Even if each follow-up is personalized and different, it is necessary to be prepared when making the diagnosis with several surgical interventions and many medical appointments, from birth to 18 or 20 years on average.

Beyond the baby’s physique, this split can cause him difficulty breathing and swallowing (which often requires specific teats and bottles), hearing discomfort, frequent ear infections or alternatively difficulty speaking. 

Necessary operations and surgery

Parents and baby will meet many medical professionals who will accompany them: pediatric anesthesiologist, surgeon, physiotherapist, pediatric ENT, pediatric orthodontist, speech therapist, pediatrician, psychologist … All can be present before and after the first operation, which takes place from 3 months. The lip, nose and hard palate can then be operated on. For a soft palate, it usually takes three more months.

The operations aim to reconstruct the labial, nasal and palatal anatomy. In general, the malformation is corrected at the end of the first year child, but additional operations may be required by the medical profession, the parents or the child, such as rhinoplasty (nose surgery).

An increasingly discreet scar

Even if surgical techniques have progressed enormously, leaving only a fine scar visible, it can be the cause of psychological suffering for the child. ” Of course, the trauma of the child and the parents in the face of this malformation depends a lot on the way in which the medical journey has unfolded. If there have been few obstacles, little pain, little mockery at school for example, the scar is generally well accepted. But if the medical course has been particularly delicate, or the social environment, especially school, was very heavy for the child, the scar is more difficult to bear. », Notes Pascale Gavelle. The psychologist gives her patients a lot of advice on how to manage to speak in the everyday life of this scar. She even wrote a book on this subject for the children concerned and their entourage: Baby smile, A story to explain the cleft lip and palate.

If Lou, Priscilla’s little boy, never had any remarks at school, Louna had to explain to her little friends why she didn’t need a bandage on her scar. “ There is a real awareness among the staff of schools, but it is unfortunately impossible to prevent the teasing of children in the face of difference. My role is therefore to reassure and inform the children, to explain to them why they have this scar, and, very important, to find their little phrase with them, the one they give so that the other children at school understand very quickly and accept this differencee », details Pascale Gavelle.

Cleft palate: what consequences for the life of the child and then of the adult?

If the operations went well, there is usually no no consequence for the future child then adult, besides a scar between the nose and the lip! On the other hand, speech therapy sessions may be needed if speaking difficulties are felt, as well as a follow-up with an orthodontist to ensure proper implantation of teeth.

* And author, with Dominique Lecuyer, of the book Baby smile, A story to explain the cleft lip and palate, Un Knoé dans les Cloups editions