Key Takeaways

  • Cleft lip and/or palate are among the most common birth defects worldwide.
  • Craniofacial abnormalities refer to conditions that affect the skull and facial bones.
  • Cleft conditions can sometimes be seen on prenatal ultrasounds.
  • Folic acid foods during pregnancy are proven to help reduce the risk of cleft lip.
Baby Cleft lip

July is National Cleft and Craniofacial Awareness and Prevention Month, a time to raise awareness about some of the most common and challenging birth conditions that affect thousands of children globally. In Malaysia, cleft conditions occur in about 1.24 out of every 1,000 live births.

Cleft lip and craniofacial conditions can range from mild to severe, but early diagnosis, proper treatment, and nutritional support, especially folic acid can make a world of difference.

Fun Fact

The #CleftLipChallenge, or #CabaranSumbingBibir in Malay, is a campaign by RMHC Malaysia to help people understand what it’s like to live with a cleft lip or palate. In the challenge, people drink from a straw with a small cut to feel how hard it can be for those with cleft conditions. They then share their experience on social media to raise awareness and support the “Gift of Smile” program.

What Is a Cleft Lip and Palate?

Cleft lip and cleft palate are openings in the upper lip, roof of the mouth (palate), or both. These happen when a baby’s facial structures don't fully close during development in the womb.

The condition can range from a small notch in the lip to a large gap that runs through the lip, gum, and palate. 

Symptoms

  • A visible split in the lip and/or palate (unilateral or bilateral)
  • Nasal-sounding speech
  • Difficulty feeding, especially with submucous cleft palate
  • Frequent ear infections
  • Liquid or food leaking from the nose while eating

Some clefts may not be visible at birth and are diagnosed later when symptoms appear.

What Are Craniofacial Abnormalities?

"Craniofacial" refers to deformities or anomalies in the skull and facial bones. These can be part of a syndrome or occur independently.

Common Types

  1. Apert Syndrome: Fused fingers and toes, small upper jaw
  2. Crouzon Syndrome: Abnormal skull shape, flat cheeks
  3. Encephalocele: Brain tissue bulging through the skull
  4. Kleeblattschädel Syndrome: Severe skull deformities, also called cloverleaf skull
  5. Pfeiffer Syndrome: Bulging eyes, beaked nose
  6. Saethre-Chotzen Syndrome: Broad head, drooping eyelids, webbed fingers
  7. Scaphocephaly: Long narrow head
  8. Trigonocephaly: Triangular-shaped forehead

Summary

A cleft is a gap in the lip or roof of the mouth that happens when a baby’s face doesn’t form completely during pregnancy. It’s common and can often be fixed with surgery. Craniofacial conditions are more serious and affect the bones of the head and face, like the eyes, nose, or jaw.

What Are Rare Craniofacial Clefts?

Rare craniofacial clefts are severe deformities that can affect both bone and soft tissue. They often occur when key parts of the baby's face fail to fuse properly during early development.

Categories:
1. Midline clefts: Affect eyes, nose, and forehead.
2. Oro-nasal-ocular clefts: Involve the mouth, nose, and eyes.
3. Lateral clefts: Associated with conditions like Treacher Collins syndrome.

These clefts are categorized by number (0–14) based on location, lower face clefts (0–7) and upper face/cranial clefts (8–14).

Causes and Risk Factors

While the exact cause of cleft lip or palate isn’t always known, several risk factors have been identified:
- Genetics: A family history increases risk.
- Environmental: Smoking, alcohol use, and certain medications during pregnancy.
- Nutritional deficiencies, especially low intake of folic acid foods, are strongly linked to cleft risk.
- Some syndromes or chromosomal abnormalities.

Importantly, research continues to show that certain foods cause cleft lip, especially when combined with other risk factors like poor prenatal care or environmental exposures. Experts agree that folic acid prevent cleft lip in many cases when taken in the early stages of pregnancy.

How To Prevent Cleft Lip And Palate During Pregnancy

Folic acid prevent cleft lip when taken before and during early pregnancy, especially in the first trimester. 

Studies show that daily intake of 400 mcg of folic acid can reduce the risk of cleft lip with or without cleft palate by about one-third. While the protective effect is strongest for cleft lip, it may not prevent cleft palate alone.

💡 A study emphasized that folic acid reduces cleft risks similarly to how it helps prevent neural tube defects.

Best Folic Acid Foods:
- Leafy greens (spinach, kale)
- Fortified cereals and breads
- Beans and lentils
- Oranges and citrus fruits
- Eggs

Eating more folic acid foods is one of the easiest and most natural ways to help folic acid prevent cleft lip in unborn babies.

Treatment Options

Treatment usually begins soon after birth and may continue into adolescence. Around 3–6 months old, babies typically undergo a lip repair, and palate repair follows before 18 months. 

Common treatments:
- Surgical repair: Typically done in stages, starting around 3–6 months of age.
- Speech therapy: To address language and articulation issues.
- Dental care: Orthodontics may be needed as the child grows.
- Ear tubes: To prevent chronic infections.
- Psychosocial support: Counseling and peer support can be helpful for both parents and children.

While surgery often brings excellent cosmetic and functional outcomes, many children need follow-up care: one study reports 31% may require revision lip surgery during growth, and nearly 60% need surgery later for palate-related issues like velopharyngeal insufficiency 

Nutrition Support & Prevention

Nutrition plays a powerful role not just in treatment, but in prevention.

Mothers are encouraged to focus on:
- Folic acid foods like fortified cereals, leafy greens, and legumes
- Prenatal vitamins that include folic acid, B12, and iron
- Hydration and avoiding foods that may cause cleft lip, especially those high in processed chemicals or associated with poor maternal health outcomes

A study supports folic acid’s protective role, especially when combined with healthy eating and prenatal care. Folic acid prevent cleft lip, and the best way to get enough is through both supplements and folic acid foods.

Misdiagnosis and Differential Diagnosis

Some clefts, especially submucous ones, may be misdiagnosed or go undetected.

Conditions with similar features:
1. Pierre Robin Sequence: A small lower jaw with a cleft palate and airway obstruction
2. Velopharyngeal insufficiency: Often mistaken for submucous cleft due to similar speech issues
3. Hemifacial microsomia: Can resemble lateral clefts
4. Syndromic craniosynostosis: May look like craniofacial clefts but are due to early suture fusion

Early imaging and evaluation by a multidisciplinary team can help clarify the diagnosis.

The Bottom Line

Having a child born with a cleft lip or craniofacial condition can be overwhelming, but with early intervention, most children go on to live healthy, happy lives. Understanding the role of folic acid foods in prevention and the risks associated with foods that cause cleft lip can empower families to make healthier choices before and during pregnancy. More awareness around how folic acid prevent cleft lip can lead to healthier pregnancies and fewer birth defects.