A cleft is a condition that affects 4,000 Filipino children every year. Most families are stuck in poverty and can't afford the surgery. As a result, the children are forced to endure the challenges brought upon by the condition. It's undeniable that there is a stigma about the cleft condition. It is up to us to raise awareness and find a solution!
Even though an orofacial cleft condition is one of the most common birth defects in the world, there is still a lack of awareness about the issue. 1 in 500 births worldwide is a child with a cleft. It is even more common in ethnic backgrounds such as Asians and American Indians. A child can develop only a cleft lip, only a cleft palate, or both. The lip and palate form separately, meaning these anomalies can be isolated or syndromic.
A cleft lip is a birth defect that happens when the lips of the child do not completely form during fetal development. Between weeks 4 and 7 of pregnancy, the face of the fetus fuses at the center to create the lips and mouth. If the tissues do not join completely, an opening or a gap between the two sides of the upper lip will form.
The gap can range from a small notch or indentation to a large gap that starts from the opening of the lip through the nose.
A cleft palate occurs when the roof of the mouth does not fully close during the development of the fetus (weeks 7 - 9 of pregnancy). This leads to an opening extending from the front of the mouth (hard palate) to the throat (soft palate).
A cleft palate is hidden inside the mouth, making it much less noticeable than a cleft lip.
Different Types of Cleft Lip and Palate
A cleft is categorized based on its location and the degree of the gap in the baby’s lips.
A unilateral defect only affects one side of the lips and can be with or without a cleft palate. This is further distinguished by complete unilateral cleft lip and incomplete unilateral cleft lip.
An incomplete unilateral cleft lip refers to a notch on the lip that does not extend to the nose. Moreover, a complete unilateral cleft lip is a gap that goes further from the opening of the lips to the nose.
The second category is a bilateral defect which concerns a gap on both sides of the lips. Similarly, it is further divided into incomplete bilateral cleft and complete bilateral cleft. A cleft palate can also accompany it.
An incomplete bilateral cleft lip means that the two notches or indentations on both sides of the lips do not go as far as the nose. With a complete bilateral cleft lip, the two openings stretch out all the way to the nose.
Causes of Cleft
The cause of cleft among infants is still unknown, but most doctors believe it is a combination of genetic (inherited) and environmental factors. Often, there is a greater chance of giving birth to a newborn with a cleft if a sibling or relative also has the condition.
Furthermore, recent studies have shown that other factors contribute to the development of cleft lip and palate, namely:
● Smoking - Pregnant women who smoke have a higher chance of having a baby with a cleft.
● Diabetes - Pregnant women diagnosed with obesity are more likely to give birth to a child with a cleft.
● Use of certain medicines - If a woman during pregnancy is taking certain medicines for epilepsy (topiramate or valproic acid), acne treatment (Accutane), or methotrexate, there is a likely chance of having a baby with cleft lip and/or cleft palate.
● Vitamin deficiency, such as folic acid.
● Birth disorders - Van der Woude syndrome, Stickler syndrome, Pierre Robin sequence or syndrome, DiGeorge syndrome, etc.
How Cleft Impacts Children?
Cleft affects children’s lives both physiologically and psychologically. Abounding In Love works with other non-profit organizations to address these various concerns.
● Feeding difficulties
Most babies with cleft palate find difficulty sucking milk from a standard bottle or breast because of the gap on the roof of their mouth. As a result, these children do not gain enough nutrients and become underweight.
In addition, the condition also leads to nasal regurgitation, referring to milk coming from the nose and taking in extra air.
● Ear Infections and Hearing loss
Children with cleft palate are prone to ear infections. The palate plays an integral role in draining fluid from the inner ear. This fluid cannot drain correctly for those with cleft palate, often leading to infection. Recurrent infections can lead to hearing loss.
● Speech Problems
Most children have difficulty communicating well because of the opening in the lip and palate. Their voices may have a nasal sound, making their speech difficult to understand. These impairments can usually be remedied with surgery and assistance from a speech pathologist.
● Difficulty Breathing
Due to a deviated septum caused by the condition, children with cleft lips have problems breathing on both sides of the nose.
● Psychosocial concerns
It is not uncommon for children with cleft to experience bullying and discrimination, which leads to emotional, social, or behavioral issues. The children feel self-conscious or have low self-confidence because of their appearance. Some children become secluded and refuse to go outside or to school because other kids tease or mock them.
● Dental Problems
Children with a cleft are susceptible to more cavities, malformed or displaced teeth, and extra (or lacking) teeth. It is also typical among children to have an alveolar ridge defect in which the permanent teeth are displaced, tipped, or rotated, or they may not erupt at all, and the alveolar ridge may not form. Proper oral surgery can usually remedy these issues.
Treatments for children with orofacial deformity depend on the severity of the condition, the child’s age and needs, and whether they have other underlying health issues.
Many experts advise that cleft lip surgeries occur when a baby is 3 to 6 months old. Moreover, a cleft palate repair is recommended within 9 to 18 months or earlier. The surgery can also help augment the child’s appearance and help rectify breathing, hearing, speech, and language problems.
Additionally, there are other treatments that can improve the lives of children with orofacial clefts, such as;
● Speech and language assessments
● Audiology assessments
● Dental and orthodontic care
● Psychosocial counseling and support
Orofacial cleft is a serious problem that affects roughly 30,000 Filipino children. With surgical care, these children could have a significantly better life; however, surgery is not easily accessible to all of them. Most families cannot afford the life-changing surgery for their children. Moreover, some children live in rural areas where the hospitals are miles away. With no means of transportation and parents barely getting by with 150 pesos/day ($3 USD), surgery might seem impossible.
With the help of non-profit organizations like, Operation Smile, Rotaplast, Faces of Tomorrow, Operation Rainbow, and others, impoverished children with a cleft can have free cleft surgery. That said, some families still cannot afford transportation to the hospital, food, and a place to stay during the medical mission. That is where Abounding in Love comes in. We “fill the gap” by providing these services to the children and parents.
In line with this, nutrition is a massive challenge for poor children with cleft. To qualify for surgery, they need to be in proper health. However, this is harder to achieve because of the challenges with a cleft, such as difficulty feeding coupled with poverty. Abounding in Love assists the children by giving them vitamins, milk, and financial support to prepare them for surgery when the next medical mission comes.
Our obligations do not end there. Abounding in Love aspires to enrich the lives of children before, during, and after surgery; thus, we commonly provide medical, financial, and educational support to our beneficiaries long after their clefts have been repaired.
What can YOU do to help?
Our mission can only be achieved with your help and support. Abounding in Love is a small non-profit organization; we rely on people like you to keep us going. If you have a heart for these brave children, CLICK HERE to learn what you can do to improve their lives.
Centers for Disease Control and Prevention. (2023, June 28). Facts about cleft lip and cleft palate. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html#:~:text=Cleft%20lip%20and%20cleft%20palate%20are%20thought%20to%20be%20caused,medications%20she%20uses%20during%20pregnancy.
The Children’s Hospital of Philadelphia. (2014, May 5). Cleft lip and palate. Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/cleft-lip-and-palate
professional, C. C. medical. (n.d.). Cleft lip and cleft palate: Causes, diagnosis & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10947-cleft-lip-cleft-palate