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Cleft Palate
The nose and lip are normal. The palate has a cleft from mid-way to the uvula at the back.
No Cleft
The structure of the nose, lip, gums, palate and uvula are fused as expected and complete.
Bilateral Cleft Lip and Palate
As per attributes on the left but more severe, impacting both nostrils. 
Unilateral Cleft Lip and Palate
One sided cleft impacting the nose (collapsed nostril), lip, gums, palate and uvula

Introduction

 

The birth of a child is a wonderful experience, filled with happiness and joy. However, when the baby is born with a cleft condition, parents will understandably be anxious, worried and in some cases, even depressed.  While that may be the initial reaction, the good news however is that a cleft condition can be effectively managed.

 

Expertise and facilities are available in Malaysia to treat and manage cleft cases. Help, moral support and counseling are available from local healthcare providers and parent-support group (CLAPAM). 

A cleft person, upon appropriate intervention, can lead a normal life. They thus deserve our collective love and support , for their future rests on what we do today.

What is Cleft?

 

Cleft is one of the more common birth condition.  Generically, the incidence rate for Malaysia is about 1 in 600-700 live births. Cleft is a split or separation in the structure of the lip or the roof of the mouth. During early pregnancy (1st trimester), separate areas of the face will develop and then join together.  When some parts fail to come together, a cleft is formed.  Cleft lip and palate can happen together or separately.

 

Cleft lip can be just a slight notch/ split on the upper lip or a complete separation in one or both sides of the upper lip.  It may go all the way up and into the nose. Unilateral cleft lip is just on one side while bilateral cleft lip is when it occurs on both sides of the lip.

 

Cleft Palate is when the roof of the mouth (palate) has not joined completely, causing the mouth and nasal areas exposed to each other.  This condition can occur at the soft palate (soft part of the palate towards the throat) or the hard palate (front part of the palate toward the mouth) or both.

 

Cleft Lip and Palate occurs when both the lip and palate have not fused properly creating a gap/hole.

What causes it?

 

To date, no definitive reason and no root cause of cleft has been identified.  Its cause is thus  deemed as multifactorial.  It can be linked to certain medications or drugs taken during pregnancy, alcoholism, smoking, infection during pregnancy, chromosome disorder and genetics. It occurs irrespective of race, religion, social-economic status and geography. It happens all over the world. 

Who's fault is it?

 

Given that there is no single root cause of cleft, there should not be any blaming on either parents or extended families.  It’s not due to something you or your husband did or did not do. Some beliefs such as the husband going fishing or cutting chicken have no scientific proofs. Do not blame yourself or anyone else! The child is a special gift from God. Treat the child with love, care and support.

 

Are there feeding problems?

 

Most cleft lip babies feed well, some can even be breastfed successfully. Cleft palate babies may have face feeding difficulties initially, with some milk coming out of the nose, causing coughing or in some cases choking. It may take a while but do not rush feeding the baby, give smaller amount of milk but at a more frequent intervals. Special feeding bottles with teats are available tohelp these babies. Spoon feeding is also encouraged, especially before and after a surgery to repair the cleft. This will help the suture line heal faster. Feed the baby in an upright position with the body and head well supported to avoid choking and fluid buildup in the middle ears.  Please refer to CLAPAM "Feeding Guide" for additional detail and tips on feeding.

 

Are there other problems to expect?

 

Ear infections and fluid build up in the middle ear is quite common in cleft children, especially for cleft palate. Temporary hearing difficulty may occur as a result and ventilation tubes such as ‘grommets’ may be placed in the eardrum to drain the fluid from the middle ear. Hearing assessment is recommended.

 

Some children with cleft palate may also face speech challenges.  An early visit to the speech therapist will help identify areas of improvement and develop a plan for the child's speech therapy.   Parents play a very important role model for the child as the parents will need to be actively involved in the process as most of the therapy will be conducted at home.

 

Oral hygiene is most important and sometime neglected. This will help the dental experts in their work to keep the good set of teeth for orthodontic works later. Avoid giving sweetened drinks, candies, sweets and chocolates unnecessarily.

 

Psychological support for both parent and child may ease the emotional difficulties faced when having a cleft condition. Growing up for a cleft child can be a challenge especially when the child starts schooling.  Name calling, teasing and making fun at the cleft child are amongst the common things they will face. As parents, teach them to be strong and confident of themselves.

 

Teachers need to be aware and sensitive about this issue. The public need to be educated to respect individuals for what they are.

 

Cleft Management Protocol

 

Cleft cases are managed through an established process called “Cleft Management Protocol”. It is used globally and outlines the type and timing of interventions to be considered. A team of specialists is required to execute the protocol. The effectiveness of the protocol is dependent on collaboration between healthcare service providers and parents/cleft patients. Parents/cleft patients are encouraged to understand the protocol that is applicable to your child’s situation and adhere to it through completion

(This is just a guideline. No cleft case is the same. Ask the doctor treating your child for the most suitable treatment plan).

Whom can I talk to?

 

In addition to doctors who sees your child, you are also encourage to talk to CLAPAM.  We are a group volunteers, consisting of parents and professionals who work with individuals (child and adult) who are born with a cleft condition.  Details of what we do are described under the "About Us" section.  Parents of cleft child and cleft adults are advised to exercise caution when seeking information through the internet or social medai such as Facebook as  not all articles/postings are applicable. Likewise, comparing the teratment of yoru child versus that of another cleft child may not be productive as each cleft is different. Each treatment plan is essentially tailored for the recipent's condition and health status.

 

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