What is a cleft lip and palate?

A cleft is an opening between two parts of the face that didn't fully join before birth. A cleft lip happens when the tissue that makes up the upper lip doesn't join completely, leaving an opening. A cleft palate happens when the tissue that makes up the roof of the mouth (the palate) doesn't join completely.^[1] A child can be born with one, or with both together, as Brandon was.

The different shapes a cleft can take

No two clefts look exactly alike. A few words you'll hear:

• Cleft lip can range from a small notch in the lip to a full split that reaches up to the nose. It can be on one side (unilateral) or both sides (bilateral), and it can extend into the gums where the teeth grow.^[2]
• Cleft palate can affect the hard palate (the bony front part of the roof of the mouth), the soft palate (the softer part at the back), or both.^[2]
• Submucous cleft palate is hidden under a thin layer of tissue, so it can be hard to spot, even for experienced doctors.^[2] It is not uncommon for it to be missed at birth.^[6]

Clefts do not cause pain or bleeding.^[2]

How and when it happens

The face forms very early in pregnancy, often before a parent even knows they're expecting. According to the CDC, the lip forms between the fourth and seventh weeks of pregnancy, and the roof of the mouth forms between the sixth and ninth weeks.^[1] Tissue from each side grows toward the middle and joins. When those parts don't fully join, a cleft forms.

What causes it?

The honest answer is that, for most babies, nobody knows. The CDC says the causes of orofacial clefts among most infants are unknown, and that they are thought to be caused by a combination of genes and other factors.^[1] Here is what the research says:

• Genes. Clefts can run in families.^[2] NIDCR notes that clefts are found in more than 400 syndromes, and that approximately 30 percent of cleft defects are associated with a genetic syndrome.^[3] Most of the time, though, a cleft is a one-off.^[4] A genetics specialist on your child's team can talk through what's known for your family.^[2]
• Things linked to a higher chance. CDC research has found that smoking during pregnancy, diabetes before pregnancy, and use of certain epilepsy medicines during pregnancy are linked to a higher risk.^[1] NIDCR also lists poor maternal health in early pregnancy and alcohol use,^[3] and the NHS adds obesity and low folic acid, noting these are linked to a small number of cases.^[4]

A "risk factor" is not the same as a cause. Many babies born with a cleft had none of these factors, and many pregnancies with them don't result in a cleft. The NHS puts it plainly: it's very unlikely to have been caused by anything you did or did not do during pregnancy.^[4] If you're a parent carrying guilt about this, please hear that.

How common it is

Clefts are among the most common birth differences.^[3] The CDC's current figures (page updated January 2026, based on national estimates for 2016–2020) are:^[1]

• About 1 in 1,031 babies in the United States is born with cleft lip with or without cleft palate.
• About 1 in 1,563 babies in the United States is born with cleft palate alone.

Some other sites still show older CDC estimates (about 1 in 1,050 and 1 in 1,600).^[2][3] Either way, it means thousands of families every year are starting this same road.

Sometimes it's a surprise

Clefts, especially cleft lip, can be found during pregnancy on a routine ultrasound.^[1] But not every cleft shows up; the NHS notes it's very difficult to detect a cleft palate on an ultrasound scan, and many are found at birth or at the newborn exam.^[4] Brandon's doctors didn't know before he was born. If it was a surprise for your family too, you're far from alone.

What it can mean day to day

Depending on the type of cleft, children may have trouble with feeding and speaking clearly, may have more ear infections and hearing problems, or problems with their teeth, and may need special dental or orthodontic care or speech therapy.^[1] Hearing problems are common enough that early and repeated hearing tests are recommended.^[5] None of this is a reason for panic. It's a reason to get connected with a cleft team early, because they check for all of it.

The good news

Clefts are treatable, and specialized cleft teams do this every day. Surgery to repair a cleft lip usually happens in the first few months of life, and surgery to repair a cleft palate is recommended within the first 18 months, or earlier if possible.^[1] MedlinePlus notes that most babies heal without problems.^[5] Our guide The care journey, step by step walks through what comes next.

Many kids born with a cleft grow up to do anything they want. One of them wrote a book about it in kindergarten.

This is general information, not medical advice. Your child's own cleft team knows your child best.