A cleft lip is a gap or opening in the upper lip that forms when facial tissues don’t fully join together during early pregnancy. In the United States, about 1 in every 1,031 babies is born with a cleft lip, with or without an accompanying cleft palate. The split can range from a small notch to a wide opening that extends up into the nose, and it can occur on one or both sides of the lip.
How a Cleft Lip Forms
A baby’s face takes shape remarkably early. Between weeks 6 and 7 of pregnancy, two structures in the developing face need to fuse together: the frontonasal process (which forms most of the upper face) and the maxillary process (which becomes the upper jaw). When these tissues fail to meet and merge properly, a gap remains in the upper lip.
Because this fusion happens so early, a cleft lip develops before many people even know they’re pregnant. The cause is usually a combination of genetic and environmental factors rather than any single thing. Known risk factors include a family history of clefting, maternal smoking during pregnancy, diabetes, and certain medications taken in the first trimester. In many cases, though, no clear cause is identified.
Types of Cleft Lip
Cleft lips vary quite a bit in their extent and location:
- Unilateral: The cleft appears on one side of the lip only. This is the most common form.
- Bilateral: There are openings on both sides of the lip.
- Incomplete: The gap does not extend up into the nostril. It may look like a notch or indentation in the lip.
- Complete: The opening extends all the way from the lip into the nostril, sometimes affecting the gum line as well.
A cleft lip can occur on its own or alongside a cleft palate, which is an opening in the roof of the mouth. The two conditions develop through related but separate processes, so having one doesn’t automatically mean the other is present.
Prenatal Detection
A cleft lip can often be spotted on a routine ultrasound during pregnancy, though reliable imaging of the fetal face isn’t typically possible until around week 15 because the head is small and positioned in ways that make it hard to see. Most cleft lips are identified during the anatomy scan performed between weeks 18 and 22. A cleft palate alone, without a cleft lip, is much harder to detect on ultrasound and is often diagnosed after birth.
When a cleft lip is found prenatally, parents can begin connecting with a care team before delivery. This preparation makes a real difference, especially for planning feeding strategies in the first days of life.
Feeding Challenges in Newborns
One of the most immediate concerns after birth is feeding. A cleft in the lip (and especially the palate) can make it difficult for a baby to create the suction needed for breastfeeding or using a standard bottle. Babies with cleft lip alone generally have an easier time than those with a cleft palate, but many still need some help.
Several specialty bottles are designed specifically for these babies. The Medela SpecialNeeds Feeder works for infants who can’t create a vacuum. The Pigeon Bottle is built for babies with cleft lip and palate. Dr. Brown’s Specialty Feeding System addresses a range of complex feeding issues, including clefts. A feeding specialist or nurse on the cleft team can help parents find the right option and learn techniques that make feedings smoother and less stressful.
Surgical Repair
The primary surgery to close a cleft lip typically happens when a baby is between 3 and 5 months old. The surgeon reconnects the muscle and tissue of the lip to close the gap and reshape the nose if needed. For most babies, this is a single procedure, though children with bilateral clefts or more complex anatomy may need the repair done in stages.
Before surgery, some babies wear a small molding device called a nasoalveolar molding (NAM) appliance. This gently guides the lip and nose tissues closer together in the weeks leading up to the operation, which can improve the surgical outcome.
Additional surgeries later in childhood are common. These may address the appearance of the lip and nose as the face grows, repair the gum line (usually around ages 7 to 9, when adult teeth start coming in), or refine nasal symmetry in the teenage years. The total number of procedures varies widely depending on the severity of the cleft.
Speech and Language Development
Children with a cleft lip alone usually develop speech normally. When a cleft palate is also involved, the picture changes. The palate plays a central role in producing many speech sounds, and even after surgical repair, some children develop articulation errors. These can be “obligatory” errors caused by remaining structural differences, or “compensatory” errors where the child learns alternative ways to make sounds that become habitual.
Speech therapy often begins early. Infants and toddlers with clefts may be evaluated to catch language delays and articulation issues before they become entrenched. Many children receive speech therapy for several years, and most achieve clear, functional speech by school age.
Hearing and Ear Health
Children with cleft palate are at elevated risk for fluid buildup in the middle ear, a condition caused by dysfunction of the Eustachian tube, the tiny canal that drains fluid from the ear to the throat. The muscles that open this tube attach to the palate, so a cleft can prevent them from working properly.
This fluid buildup tends to come and go, and when present, it can cause mild to moderate hearing loss. Many children with cleft palate need small ear tubes placed during their first year or two to keep the ears draining and protect their hearing during the critical window for language development. Permanent hearing loss from nerve damage is less common but does occur in some cases.
Dental Concerns
When a cleft extends through the gum line, it can affect how teeth develop. Missing teeth, extra teeth, or teeth that come in rotated or out of position are all common in the area of the cleft. Misalignment of the upper and lower jaws (malocclusion) is also frequent. Most children with clefts involving the gum will need orthodontic treatment, and some require a bone graft to fill in the gap in the gum before their permanent teeth can fully come in.
The Care Team
Cleft care involves a wide range of specialists working together over many years. A typical cleft team includes plastic or craniofacial surgeons, pediatric dentists, orthodontists, speech-language pathologists, audiologists, ear/nose/throat doctors, geneticists, social workers, and nurses. The American Cleft Palate-Craniofacial Association maintains a directory of accredited teams across the country.
Most families see their cleft team on a regular schedule from birth through late adolescence, with visits tapering off as the child grows and fewer interventions are needed. The long timeline can feel daunting, but the majority of children born with a cleft lip grow up with normal speech, healthy hearing, and a barely visible scar.