July is celebrated as National Cleft and Craniofacial Awareness and Prevention Month (NCCAPM). Cleft and craniofacial defects affect a lot of new-borns or infants every year – one out of every 1000 baby is born with this birth defect every year (Karnon: 2020) [https://www.boldsky.com/health/disorders-cure/cleft-lip-and-palate-causes-symptoms-risks-treatment-prevention-133898.html].

The lip forms between the fourth and seventh weeks of pregnancy. As a baby develops during pregnancy, body tissue and special cells from each side of the head grow toward the centre of the face and join together to make the face. This joining of tissue forms the facial features, like the lips and mouth. A cleft lip happens if the tissue that makes up the lip does not join completely before birth and this results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.

Cleft lip and cleft palate are amongst the most common birth defects. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes. Having a baby born with a cleft can be upsetting, but the cleft lip and cleft palate can be corrected, and in most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.

Symptoms

Usually, a split (cleft) in the lip or palate is immediately identifiable at birth. Cleft lip and cleft palate may appear as:

• A split in the lip and roof of the mouth (palate) that affects one or both sides of the face
• A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose
• A split in the roof of the mouth that does not affect the appearance of the face

Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth’s lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous cleft palate may include:

• Difficulty with feedings
• Difficulty swallowing, with potential for liquids or foods to come out the nose
• Nasal speaking voice
• Chronic ear infections

Risk factors

Several factors may increase the likelihood of a baby developing a cleft lip and cleft palate, including:

• Family history. Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.
• Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol or take certain medications.
• Having diabetes. There is some evidence that women diagnosed with diabetes before pregnancy may have an increased risk of having a baby with a cleft lip with or without a cleft palate.
• Being obese during pregnancy. There is some evidence that babies born to obese women may have increased risk of cleft lip and palate.

Males are more likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females. In the United States, cleft lip and palate are reportedly most common in Native Americans and least common in African-Americans.

Prevention

After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate cannot be prevented, consider these steps to increase your understanding or lower your risk:

• Consider genetic counselling. If you have a family history of cleft lip and cleft palate, tell your doctor before you become pregnant. Your doctor may refer you to a genetic counsellor who can help determine your risk of having children with cleft lip and cleft palate.
• Take prenatal vitamins. If you’re planning to get pregnant soon, ask your doctor if you should take prenatal vitamins.
• Don’t use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a birth defect.

This month is intended to raise awareness of the risk factors that are responsible for cleft and craniofacial defects in unborn babies as well as provide their families with good medical treatments, quality of life and proper management of the condition (Mayo Clinic Staff: 2020).