The care journey, step by step

Every child is different, and your cleft team will set the plan and the timing. This is a general picture of what many families experience, so the road ahead feels less unknown. The ages below come from published timelines; you'll notice they don't all match exactly, because teams and countries do things a little differently. That's normal.

Your cleft team

A cleft team brings together all the specialists your child may need, working together. Team care can begin as early as the prenatal period and lasts throughout childhood, sometimes into early adulthood.^[1]

ACPA-approved teams are required to include a care coordinator, an orthodontist, a speech-language pathologist and a surgeon, and to have access to an audiologist, geneticist, nurse, ear, nose and throat doctor (ENT), pediatrician, pediatric dentist or prosthodontist, and a psychologist, social worker or other mental health specialist.^[2] You won't see everyone at every visit. Often you'll see several people on one clinic day, and they talk to each other so you don't have to repeat your story.

A typical path

1. Before birth (if the cleft is found on a scan). Some families meet their team during pregnancy.^[1] It's a good time to ask about feeding and who your contact person will be.^[12]
2. The first weeks: feeding and hearing. Babies with a cleft palate can't create the suction needed to feed from a regular nipple, so they usually use a specialty bottle; babies with a cleft lip only often feed well without special equipment.^[8] Regular weight checks help make sure your baby is growing.^[8] In the NHS pathway, feeding support and hearing tests start in the first 6 weeks.^[4]
3. Around 1–4 months: possible pre-surgery molding. For some wider clefts, a team may use nasoalveolar molding (NAM), a custom appliance that narrows the cleft and shapes the nose before surgery.^[6] Not every team or child uses it.
4. Around 3–6 months: lip repair. The CDC says lip repair usually happens in the first few months of life.^[3] MedlinePlus gives about 3 to 6 months,^[5] and the NHS says usually around 3 months.^[4]
5. Around 6–18 months: palate repair. The CDC recommends palate repair within the first 18 months of life, or earlier if possible.^[3] In practice, published timelines range from 6 to 12 months (NHS)^[4] and 9 months to 1 year (MedlinePlus)^[5] to 10 to 14 months (Duke Health).^[6] Repairing the palate early supports speech development.^[5]
6. Ears, all through the early years. Children with a cleft palate are more likely to have ear infections and hearing problems.^[3] If fluid stays behind the eardrum, a doctor may recommend ear tubes (small tubes placed through the eardrum).^[9] Some teams place them during palate surgery.^[6]
7. Toddler and preschool years: speech. Speech-language assessments and therapy often begin around age 1.^[6] The NHS pathway checks speech at 18 months, 3 years and 5 years,^[4] and CLAPA describes the goal as clear speech by about age 5.^[7] If speech stays very nasal, some children have a speech surgery, often around ages 4 to 6.^[6]
8. School years: teeth and gum bone graft. If the cleft goes through the gum, many children have an alveolar bone graft, which fills the gap in the gum bone so adult teeth have bone to grow into. CLAPA and the NHS give a usual age of about 8 to 12 years;^[10][4] Duke Health gives 7 to 10.^[6] The exact timing depends on how the adult teeth are coming in.^[10] Orthodontists often expand the palate first.^[11]
9. Pre-teen and teen years: braces. Orthodontic treatment is common in the teen years.^[11] The NHS pathway places orthodontics and jaw-growth checks at about 12 to 15 years.^[4]
10. Late teens: if needed, jaw or nose surgery. Some young people are offered jaw surgery once the face stops growing, at around 16 to 18 years (CLAPA)^[7] or 17 to 19 (Duke Health).^[6] Nose surgery (rhinoplasty) or lip revision, if wanted, is often done after growth is complete.^[6][7] Many of these later operations are optional, and teens get a real say.

Brandon had his first batch of surgeries over his first two years. Your child's timeline may look different, and that's okay.

Things that help along the way

• Keep one folder (paper or phone) with dates, names, surgeries and questions. Teams change people over the years; your notes don't.
• Ask who your main contact person is after birth and after each surgery.^[12]
• Ask which feeding bottle the team prefers and who can help with feeding at the birth hospital.^[12]
• Ask how team members communicate with each other and with you.^[12]
• As your child grows, bring them into the conversation. Their voice matters in decisions about their own face.

Finding a team

ACPA calls choosing a team one of the first and most important decisions you will make, and suggests searching for an ACPA-approved team near you or asking your local doctor.^[12] ACPA's free directory lets you search by distance and filter for approved teams: Find an ACPA Approved Team.^[13] Outside the US, ask your doctor or national cleft organization (in the UK, for example, CLAPA and NHS cleft services).

This is general information, not medical advice. Your child's own cleft team will set the plan.