Family history of orofacialclefting

Evidence of feeding difficulties, appropriate weight gain

Monitor for appropriate weight gain

Additional medical problems and associated syndromes

The examination should focus on four features: Nose, lip, alveolus, and palate

• 
  

  Cleft lip and palate classification

  
  
  
  
  • 
    

    Unilateral versus bilateral

    
    
  • 
    

    Complete (involvement of nasal floor) versus incomplete

    
    
  • 
    

    Isolated cleft lip (primary palate) versus cleft lip and palate (primary and secondary palates)

Additional facial dysmorphic features

• 
  

  Lower lip pits: Van der Woude syndrome (autosomal dominant)

Complete physical examination to look for any other anatomic abnormality

• 
  

  Consider possibility of syndromic presentation

Echocardiogram, renal ultrasound, skeletal X- rays, etc., depending on physical findings

Children with clefts are ideally cared for by multidisciplinary team: Plastic surgery, otolaryngology, speech pathology, audiology, child/developmental psychology, nursing, pediatric dentistry, orthodontics, and oral and maxillofacial surgery.

Specialized nipples/bottles: Dr. Brown bottle, Haberman nipple (with a squeezable tip) or Pigeon nipple (with crosscut opening for faster flow)

General principle is to hold infant at 45 degrees and drip formula into the mouth and allow the infant to swallow.

Babies with cleft palate cannot create adequate suction on a bottle or breast.

Weight gain: After the first 2 weeks of life, the child should gain half a pound every week