Diana French, age 15, of Utica, N.Y., for her question:
WHAT CAUSES A CLEFT PALATE?
A cleft palate is an opening in the roof of the mouth. About one in every 800 babies is born with this birth defect. Sometimes the baby will also have a cleft lip, commonly called a harelip. Other times the baby may have a cleft lip and not a cleft palate.
Doctors are not sure why some babies are born with these defects. Statistics do show that babies with cleft palates and lips are more likely to be born to older parents and they tend to weigh less than normal babies, even when they are not born prematurely. Figures also indicate that cleft palate and lip defects are more common among Japanese and rare among blacks.
Studies have been made with animals that indicate an inadequate diet in pregnancy may play a part in these birth defects. But human mothers who are well off, well educated and presumably well fed seem to have babies with cleft palates and lips as often as those who are less fortunate. The cleft may be in the soft palate, at the back of the mouth, or in the hard palate, leaving an opening into the nasal cavity. It may divide the upper lip or the bony alveolar ridge that holds the upper teeth. In more severe cases it cuts all the way through the top of the mouth and the upper lip, either on one side or on the other. Correcting the cleft and the problems related to it is a long process and should be started early. Depending on the needs of the child, it may require collaboration by specialists in dentistry, surgery, speech correction, psychotherapy and other fields.
To prevent speech difficulties, a very young child may be fitted with a lightweight appliance, like an upper denture plate, to close off the cleft until he is ready for surgery. An older child with a cleft that cannot be successfully repaired by surgery can be given a similar appliance.
Closing the cleft solves only part of the problems for a child with a cleft palate. As a baby, he must be fed in a special way. Later, as he grows older, he will need a great deal of special dental care, such as braces to bring his teeth into proper alignment.
He is likely to need speech therapy so he can learn to speak more normally, with a less nasal sound. He may need to have old scars removed, a malformed nose straightened or medical care for frequent middle ear infections which could lead to hearing impairment. He and his family may also need counseling or psychotherapy to help them accept the burdens that a cleft palate handicap places on all of them.
A cleft upper lip is sometimes called a harelip because it resembles the divided upper lip of a hare. It usually runs from the edge of the lip into the nostril, or may be on one side, usually the left, or on both.