Airway concerns (especially with small jaw – Pierre Robin sequence).

Feeding concerns, appropriate weight gain

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  Infants with cleft palate are not able to breastfeed because of their inability to create appropriate suction.

Exposures during pregnancy (alcohol, anticonvulsants, corticosteroids).

Family history of orofacial clefting or craniofacial syndromes.

Additional medical problems

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  Children with isolated cleft palate have a 40% incidence of syndromic presentation.

Evaluate for facial dysmorphic features.

Classify the extent of cleft and involved structures.

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  Primary and/or secondary palate (dividing point is incisive foramen).

  
  
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  Complete or incomplete.

  
  
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  Unilateral or bilateral (vomer visible on one or both sides): May not always be classified if hard palate is not affected.

Evaluate for Pierre Robin sequence (micrognathia or retrognathia, glossoptosis, and airway difficulties).

Head-to-toe examination for any other anatomical abnormality or evidence of syndromic presentation

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  Van der Woude syndrome (autosomal dominant): cleft lip and/or palate with lower lip pits.

  
  
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  Isolated cleft palate more likely to have associated anomalies than cleft lip and palate.

Evaluate other organ systems (e.g., echocardiography, renal ultrasound, X-rays of the spine) if suspicion for other congenital anomalies or a syndrome.

Genetic testing if a syndrome is suspected. Chromosomal microarray analysis is frequently used.