One of every 940 children in the United States is born with cleft lip (with or without cleft palate), and one of every 1,574 is born with cleft palate without cleft lip. This means that more than 4,000 children are estimated to be born with such an orofacial defect each year in the U.S. alone.
What is cleft palate?
Cleft palate occurs when the tissue that makes up the roof of the mouth fails to join together during pregnancy. Both the front and back areas of the palate may remain open, or only part of the palate may remain open.
What is cleft lip?
Cleft lip occurs when the tissue that forms the lip does not join together before birth. The opening can be a small slit or a larger opening that reaches up to the nose.
How cleft lip and/or palate affects sleep
Studies suggest that children with cleft lip and/or palate (CL/P) may be more likely to experience sleep-related breathing disorders such as obstructive sleep apnea.
An Australian study involving 248 families of children with a confirmed cleft diagnosis identified obstructive sleep apnea (OSA) in 31.4 percent of those children.
To compare, OSA usually affects only between one and 10 percent of children. Interestingly, the study did not find any relationship between the extent or severity of CL/P and OSA risk.
What are the symptoms of OSA in children?
Symptoms of OSA are often seen as common in children, which means their importance can be overlooked.
Children with CL/P should have the following symptoms investigated to determine whether the child is suffering from OSA:
-
Bed wetting
-
Frequent snoring
-
Daytime sleepiness
-
Heavy or loud breathing
-
Hard to wake in the morning
-
Waking with a dry mouth and/or headache
Prevention and solutions
We still don't know exactly what causes cleft lip or palate. Although it’s thought that genes play a big role, the Centers for Disease Control and Prevention has also identified the following factors that may increase the chance of having a baby with CL/P:
-
A mother who smokes during pregnancy
-
A mother with diabetes diagnosed before pregnancy
-
A mother who takes certain medications for epilepsy during the first trimester of pregnancy
Cleft lip can usually be identified during routine 20-week ultrasounds. Cleft palates can be harder to identify during pregnancy, although 3D ultrasounds are beginning to make detection easier.
Treatments for cleft palate vary based on the severity of the condition and the age of the child. Surgery for cleft lip typically takes place within the first 12 months after birth. Surgery for cleft palate should take place within the first 18 months.
Other treatments for OSA due to CL/P may include:
-
Prone positioning (note that this goes against advice to always place a baby on his or her back when sleeping – so be sure to consult your doctor first)
-
Insertion of a nasopharyngeal airway
-
Adenotonsillectomy (removal of adenoids and tonsils)
If your child is also overweight, restricting caloric intake may also help reduce the symptoms of OSA.