American Medical Association Family Medical Guide - American Medical Association [180]
In most cases, the cause of cleft lip and cleft palate is unknown, but both genetic and nongenetic factors appear to play a role. The abnormalities sometimes can run in families and may affect more than one child in a family. For this reason, if you have a child with a cleft lip or palate, or if you have a repaired cleft, it’s a good idea to see a genetic counselor (see page 952) to determine your risk of having a child with the same birth defect in the future.
Diagnosis and Treatment
All newborns are checked for cleft lip and cleft palate, which are obvious at birth. If a baby has a cleft, the doctor will examine him or her immediately to determine the extent of the defect.
A baby with a cleft lip or cleft palate will need to have corrective surgery. He or she is likely to receive care from a team of specialists, including a pediatrician, speech therapist, orthodontist (a dentist who specializes in correcting irregularities of the teeth), pediatric dentist, plastic surgeon, and otolaryngologist (a doctor who specializes in disorders of the ear, nose, and throat).
Cleft lip and cleft palate
A cleft lip (above left) can vary in severity from a notch in the upper lip to a split extending to the base of the nose. It can occur on one or both sides of the nose. In some cases, a cleft lip extends into the roof of the mouth (palate), forming a cleft palate (above right). A cleft palate also may occur alone.
Surgery to correct a cleft lip is recommended when a child is about 10 weeks old. Treatment from birth until the surgery varies according to the severity of the abnormality. Infants who do not have problems eating do not need any special care during this time. However, some bottle-fed babies may need a special nipple or a nipple with a larger than normal hole. Babies usually stop regurgitating milk through their nose on their own after a few weeks.
Surgery for a cleft palate is more extensive than that for a cleft lip. It is usually done when the child is a little older (usually between 9 and 18 months of age), preferably before he or she learns to talk. Before the surgery, if the baby is having trouble feeding, a dentist will make a device that fits into the roof of the baby’s mouth to cover the cleft while he or she is eating. A brace may be placed on the upper gum in the area around the cleft if the gum is out of alignment. Occasionally, a baby may need to be fed through a tube placed in the nose or mouth that extends into the stomach. For long-term tube feeding, the tube may be inserted into the stomach through a small surgical incision in the abdomen.
In some cases, to help prevent ear infections, an otolaryngologist may place a small plastic tube inside each of the child’s eardrums at the time of cleft palate surgery. The tubes help air circulate across the eardrum and allow fluid to drain normally. Some children require additional surgery when they get older to improve their appearance. Your child also will need to see an orthodontist to make sure his or her teeth are growing in properly. Depending on your child’s situation, your doctor may recommend speech therapy and regular hearing checkups. (Most children have normal speech development after this type of surgery.)
Hypothyroidism
The thyroid gland is a butterfly-shaped gland at the front of the base of the neck that produces the hormones thyroxine and triiodothyronine, which are important for growth and metabolism (the chemical processes that take place in the body). The thyroid also produces calcitonin, which helps regulate the calcium level in the blood and enhances bone formation. Hypothyroidism is a hormonal disorder in which the thyroid gland is under-active and does not produce enough thyroid hormone. As a result, all of the chemical processes in the body slow down.
Hypothyroidism can be congenital, resulting when a child is born without a thyroid gland. Some