What to Expect as your Child Grows

Infancy

The plastic surgeon repairs the cleft lip shortly after birth, usually at two to three months of age, and repairs the cleft palate by 12 months of age, prior to the child’s first speech. Many cleft lip/palate children develop hearing problems as a result of chronic ear infections, which, left untreated, create speech and language problems. Audiologists and otolaryngologists assess the child’s ears. Tubes may be placed in the child’s ears to help treat the infections and maximize hearing sensitivity. Some children may require gum repair with bone grafting in infancy, typically sometime after the lip repair and before the repair of the cleft palate.

Age two to four months:
Cleft lip repair
Ear exam/tubes

Age six to eight months:
Bone (rib) graft to the gum (only if the arch segments come into good alignment: not every child)

Six to 12 months:
Cleft palate repair
Ear exam/tubes

Childhood

The child’s speech development is regularly assessed by the speech and language pathologist. If treatment is needed, the speech therapist works with the parent, the child and a local speech pathologist. Sometimes additional surgery, to improve the function of the palate and pharynx (throat), is needed when speech therapy alone will not improve the child’s ability to speak normally. Before the child begins school, significant residual deformities of the lip and nose may be surgically corrected to minimize the psychological effect of the cleft. Pediatric dental and orthodontic services begin to play a more important role during the later years in childhood. Surgery to restore the residual cleft in the dental arch is frequently accomplished at this age.

Three to six years

Pharyngeal (throat)/soft palate surgery to improve speech (not every child)

Five to seven years
Nose surgery (if the deformity is severe: not every child)

Six to nine years

Bone (hip) graft to gum (if the child had no rib graft in infancy or lacks sufficient bone to support teeth)

Adolescence

While nearly all cleft children will need orthodontia (braces), a smaller number of children will need orthognatic (jaw) surgery. In these children, the growth of the upper jaw remains behind the lower jaw and the face develops a sunken appearance as the child grows into adolescence. The surgery involves repositioning the jaws to improve the child’s bite and appearance. The plastic surgeon carefully plans the surgery with the dental specialists (dentist, orthodontist and prosthodontist) to achieve the best results. Once the facial bones are in the correct relationship, the final nose and lip surgeries are completed.

14-18 years

Facial skeletal surgery (if the upper jaw does not grow in proper relation to the lower jaw: not every child)
Cleft rhinoplasty, or nose surgery (almost every child requires final corrections)
Other surgeries may be required depending on the deformity. Frequent lip and nose revisions may be needed.

What to expect during treatment in the clinic

What to expect when your child undergoes surgery.

How to help your child handle teasing.