“Harelip disease” is an old word for a birth difference where the upper lip does not join together in the middle before birth. Today doctors say cleft lip instead, because “harelip” is now seen as hurtful and disrespectful. A cleft lip can be a small notch in the lip or a wide opening that goes up toward the nose. It can happen on one side of the lip (unilateral) or on both sides (bilateral). Sometimes it also involves the bone of the upper gum and the front part of the roof of the mouth.
“Harelip” is an older name for cleft lip. Cleft lip is a birth condition where the upper lip does not join fully while a baby is growing in the womb. The opening can be small (a tiny notch) or large (a wide split) and may be on one side or both sides. It can happen alone or together with a cleft palate (an opening in the roof of the mouth). In many babies, the exact cause is not known, and it may come from a mix of genes and pregnancy factors.
This problem starts early in pregnancy when parts of the baby’s face are forming. Normally, tissues of the upper lip grow from the sides and meet in the middle. In cleft lip, these tissues do not fully join, so a gap stays open.
Because the old word “harelip” compares people to animals, many people with cleft lip feel it is insulting. Health groups and cleft support groups strongly advise using “cleft lip” or “cleft lip and palate” instead.
Other names
Cleft lip has several other names or phrases that people may use:
“Cleft lip” is the most correct and respectful modern medical term.
“Cleft lip and palate” is used when the split in the lip happens together with a split in the roof of the mouth.
“Orofacial cleft” is a broader term that includes cleft lip, cleft palate, or both, and is often used in research papers.
“Labial cleft” is a more technical phrase sometimes used by surgeons, meaning a cleft of the lip.
“Non-syndromic cleft lip” is used when the cleft lip happens alone, without other birth defects or genetic syndromes.
Types of cleft lip
There are several common types of cleft lip, based on how wide the opening is and where it is. Doctors often describe them like this:
Unilateral incomplete cleft lip means the cleft is on one side of the lip and does not go all the way into the nose. It may look like a notch or partial split.
Unilateral complete cleft lip means the cleft is on one side and goes from the lip all the way into the nostril, often affecting the shape of the nose and upper gum.
Bilateral incomplete cleft lip means there are splits on both sides of the lip, but they do not fully reach the nose. The center part of the lip is still partly attached.
Bilateral complete cleft lip means there are wide clefts on both sides, extending into both nostrils. The middle segment of the lip and gum can look like a small separate piece.
Cleft lip with cleft palate means the split in the lip is joined with a split in the hard and/or soft palate, affecting the roof of the mouth as well as the lip.
Causes and risk factors
Cleft lip usually has many causes together. Most cases are from a mix of genes and environmental factors, not just one single cause.
1. Family history of cleft lip
If a parent or close relative has a cleft lip or palate, the baby’s risk is higher. This shows that genes play a strong role.
2. Specific genetic syndromes
More than 300 genetic syndromes include cleft lip or palate as part of their features, such as some chromosomal or single-gene conditions.
3. Gene–environment interaction
Some babies have genes that make them more sensitive to things like cigarette smoke or certain medicines, so these exposures increase their cleft risk more than in other babies.
4. Maternal smoking during pregnancy
Smoking while pregnant is one of the best-proven risk factors. Toxins in smoke can disturb the normal growth of the baby’s face.
5. Maternal alcohol use
Heavy use of alcohol in pregnancy can damage the developing baby and is linked with cleft lip and palate, especially in the setting of fetal alcohol spectrum disorders.
6. Lack of folic acid (vitamin B9)
Not taking folic acid supplements and having a low-folate diet during early pregnancy is linked with more cases of cleft lip and palate.
7. Poor overall maternal nutrition
Mothers who are under-nourished or have low intake of key vitamins and minerals have a higher chance of babies with orofacial clefts.
8. Maternal obesity
Some studies show that being obese before pregnancy or early in pregnancy is related to a higher risk of cleft lip and palate.
9. Maternal diabetes
Pregnant women with poorly controlled diabetes have a higher risk of several birth defects, including cleft lip and palate.
10. Certain anti-seizure medicines
Some anticonvulsant drugs, such as older medicines like phenytoin or valproate, are linked to a higher rate of cleft lip and other defects when taken in early pregnancy.
11. Retinoic acid (vitamin A derivatives)
High doses of retinoic acid (used in some acne drugs) during pregnancy can disturb facial development and increase cleft risk.
12. Other teratogenic drugs and chemicals
Exposure to some other medicines, industrial chemicals, or pesticides that affect fetal development may contribute to cleft lip in susceptible families.
13. Maternal infections in early pregnancy
Some infections during the first trimester, such as rubella or other systemic viral illnesses, have been associated with facial malformations including clefts.
14. Maternal fever or hyperthermia
High body temperature from severe fever or hot tub/sauna exposure in early pregnancy may interfere with normal tissue fusion in the face.
15. Advanced maternal age
Pregnancies at older maternal ages sometimes carry more risk for congenital anomalies, including cleft lip and palate.
16. Low maternal age with high-risk exposures
Very young mothers who also smoke, drink, or have poor diet may have increased risk due to combined social and biological factors.
17. Low socioeconomic status
Poverty can lead to less access to healthy food, supplements, prenatal care, and counseling about medicines, which can increase the chance of cleft.
18. Environmental pollution
Living close to heavy traffic, factories, or agricultural chemicals may expose pregnant women to pollutants that have been linked in some studies to orofacial clefts.
19. Consanguineous marriage (parents related by blood)
Marriages between close relatives can increase the chance of recessive genetic changes, and some populations with more consanguinity show higher cleft rates.
20. Unknown or idiopathic causes
In many babies, no clear cause or risk factor can be found even after careful testing. In these cases, doctors say the cleft is idiopathic or multifactorial, meaning it comes from a complex mix of genes and environment.
Symptoms and signs
1. Visible gap in the upper lip
The main sign is a split, notch, or opening in the upper lip that can be small or very wide. It may affect one side or both sides of the lip.
2. Distorted shape of the nostril
In complete cleft lip, the nostril on the affected side is often flattened or pulled upward, and the nasal tip can look twisted.
3. Opening in the gum or upper jaw
The cleft may extend into the upper gum and the bone under it, leaving a gap where the teeth should come in later.
4. Feeding difficulty in newborns
Some babies cannot make a good seal on the breast or bottle, so milk leaks out or they take a long time to feed. Feeding problems are worse when cleft palate is also present.
5. Milk coming out of the nose
If the cleft involves the palate, milk can flow from the mouth up through the nose because the mouth and nose are not fully separated.
6. Poor weight gain or failure to thrive
Because feeding is harder, some babies do not gain weight well and may fall below their expected growth curves if feeding support is not given.
7. Frequent ear infections
Cleft palate can affect the muscles that open the eustachian tube, so fluid collects in the middle ear and infections happen often.
8. Hearing loss
Long-term middle ear fluid and infections can reduce hearing. Some children need ear tubes and regular hearing checks.
9. Nasal-sounding or unclear speech
If the palate is not repaired early enough, air escapes through the nose when the child talks, giving a nasal voice and making some sounds difficult to pronounce.
10. Dental problems
Teeth near the cleft may be missing, extra, crooked, or poorly formed, and the upper jaw may be narrow or pushed back.
11. Difficulty with blowing, whistling, or sucking
Children with a cleft may struggle to blow up balloons, whistle, or use straws because they cannot build strong pressure inside the mouth.
12. Facial growth differences
Some children develop mid-face retrusion (flat upper jaw) or asymmetry of the nose and lip as they grow, especially if the cleft is severe.
13. Social and emotional problems
Visible facial differences and speech problems can lead to teasing, bullying, low self-esteem, or social anxiety if support is not given.
14. Sleep and breathing issues
In some cases, changes in the nose and jaw, or scarring from surgeries, may narrow the airway and contribute to snoring or breathing difficulty during sleep.
15. Associated anomalies in syndromic cases
When cleft lip is part of a syndrome, the baby may also have heart defects, limb problems, or other organ issues that must be checked.
Diagnostic tests
Cleft lip is often easy to see at birth, but doctors still do several tests to understand the full problem, check hearing and feeding, and look for other conditions. Some tests are done before birth, and some after birth.
Physical exam tests
1. Full newborn physical examination
Right after birth, the doctor checks the baby from head to toe. They look at the lip, nose, mouth, limbs, heart, and other organs to see if the cleft is isolated or part of a larger syndrome.
2. Detailed head and face examination
The doctor carefully inspects the shape of the lip, nostrils, upper jaw, and eyes. They note if the cleft is unilateral or bilateral, complete or incomplete, and whether the nose or mid-face is affected.
3. Intraoral (inside mouth) examination
A light and tongue depressor are used to look inside the mouth. The doctor checks the hard and soft palate, uvula, gums, and teeth (if present) to see if there is a cleft palate or gum involvement.
4. Growth and nutrition assessment
Weight, length, and head size are measured and compared with growth charts. If the baby is not gaining weight as expected, this points to feeding difficulty and the need for special feeding support.
Manual tests
5. Palpation of lip and gum margin
The doctor gently feels the edges of the lip and upper gum with gloved fingers. This helps them feel how wide the cleft is, how much bone is missing, and how the tissues move, which is important for surgical planning.
6. Palpation of the hard palate
With a gloved finger, the clinician feels along the roof of the mouth to check for hidden or “submucous” clefts that might not be obvious just by looking.
7. Functional suck and swallow assessment
A specialist, often a speech-language pathologist or feeding therapist, watches the baby during feeding. They feel the jaw and cheeks and check how well the baby can suck, swallow, and coordinate breathing during a feed.
8. Speech articulation assessment (in older children)
When the child is old enough to talk, a speech therapist listens while the child says certain sounds and words. They may feel the cheeks and throat to see if air leaks through the nose or if some sounds are difficult.
Lab and pathological tests
9. Basic blood tests for general health
Simple blood tests such as full blood count and biochemistry are done before surgery to check the child’s general health, look for anemia, and see if it is safe to give anesthesia.
10. Genetic counseling and family history review
A genetics doctor or counselor takes a detailed three-generation family history and reviews medical records to see if the cleft might be part of a hereditary pattern. This is not a lab test itself but guides further testing.
11. Chromosomal analysis (karyotype)
If the baby has other anomalies (for example heart defects or limb problems), blood may be taken to study the chromosomes. This can detect conditions such as trisomies or other chromosomal rearrangements.
12. Targeted genetic panels or exome testing
In suspected syndromic cleft or in families with more than one affected child, more detailed DNA tests can look for specific gene changes known to cause cleft lip and palate.
13. Prenatal blood tests with ultrasound correlation
In pregnancy, if a cleft is seen on ultrasound, parents may be offered maternal blood tests and, in some settings, invasive sampling (like chorionic villus sampling) combined with genetic analysis to check for associated syndromes.
Electrodiagnostic tests
14. Brainstem auditory evoked response (BAER) test
This hearing test uses small electrodes on the baby’s head to measure how the brain responds to sounds. It helps detect hearing loss in babies with cleft palate who cannot do standard hearing tests yet.
15. Tympanometry with acoustic reflex testing
Although partly mechanical, this test uses sound and pressure changes to see how well the eardrum and middle ear move. It helps confirm fluid build-up behind the eardrum, which is common in children with cleft palate.
16. Detailed audiometry in older children
When the child is older, they can do pure-tone audiometry or play audiometry. Headphones and sound signals are used, and responses are measured to map out hearing levels across different pitches.
17. Nerve function tests in rare cases
In unusual situations where facial nerve weakness is suspected, doctors may use electrical tests such as nerve conduction studies or electromyography to see how well the facial muscles and nerves are working.
Imaging tests
18. Prenatal 2D ultrasound
Standard two-dimensional ultrasound during mid-pregnancy can often show a cleft lip, especially when the sonographer looks carefully at the baby’s face in profile and front views.
19. Prenatal 3D ultrasound
Three-dimensional ultrasound gives a more detailed view of the baby’s face, making it easier to see the exact shape of the lip and nose, and sometimes the palate. It is used as a follow-up when a cleft is suspected on 2D scan.
20. Prenatal MRI (magnetic resonance imaging)
In some high-risk pregnancies or complex cases, MRI of the fetus may be used along with ultrasound to get more detail about the palate, brain, and other structures, without using radiation.
21. Postnatal skull and dental X-rays
As the child grows, dentists and orthodontists may take X-rays of the teeth, jaws, and skull to plan dental and jaw treatment. These images show missing teeth, jaw position, and how the cleft area is growing.
22. CT scan of the face and jaws
A CT scan gives 3D images of the bones of the face and maxilla (upper jaw). It is helpful for planning major surgeries, such as bone grafting to the gum or later jaw surgery in teenagers.
23. Nasendoscopy or video-fluoroscopy of the palate (functional imaging)
For children who still have speech problems after surgery, doctors may use a small camera through the nose or moving X-ray pictures during speech to see how the palate moves and where air is leaking.
Non-pharmacological treatments (therapies and other care)
1) Team-based cleft care (cleft team). This means one coordinated team plans the whole journey—feeding help, surgery timing, hearing checks, speech support, dental care, and long-term follow-up. The purpose is to avoid “gaps” in care. The mechanism is simple: many small problems (feeding, ears, teeth, speech) are managed early and together, so the child grows with fewer complications.
2) Early feeding assessment and coaching. A trained nurse or feeding specialist checks how the baby drinks milk and gains weight. The purpose is safe feeding and good growth before surgery. The mechanism is improved latch/position and better milk flow control, which reduces tiredness, choking, and poor weight gain.
3) Breastfeeding positioning support (when possible). Many babies with cleft lip only can breastfeed well with small position changes. The purpose is to keep breastfeeding comfortable and effective. The mechanism is that breast tissue can help seal the gap, and positioning helps the baby keep suction and swallow more smoothly.
4) Special bottles and teats (when needed). Some babies need a wide-based teat or a soft, squeezable bottle to help milk flow. The purpose is to make feeding easier and safer. The mechanism is controlled milk delivery without the baby needing strong suction, which is helpful when the mouth seal is weak.
5) Burping strategies and slower pacing. Caregivers learn to pause, burp more often, and keep feeds calm. The purpose is to reduce air swallowing, vomiting, and discomfort. The mechanism is less trapped gas and less pressure in the stomach, so feeding becomes smoother and weight gain improves.
6) Nasoalveolar molding (NAM) / presurgical molding (selected babies). NAM is a device used in some infants before surgery to gently guide the gum and nose shape. The purpose is to reduce the gap and improve nose shape before lip repair. The mechanism is slow, guided pressure during early infancy when tissues are more moldable, which can make surgery easier in some cases.
7) Lip taping or external strapping (selected cases). Some teams use taping to gently bring lip segments closer before surgery. The purpose is to reduce tension on the future repair. The mechanism is gentle, consistent pull over time that can narrow the cleft in certain babies when used correctly by trained staff.
8) Parent education and mental support. Parents often feel stress or guilt, even though cleft lip is not anyone’s fault. The purpose is confidence and good home care. The mechanism is simple: clear instructions plus emotional support improves feeding success, follow-up attendance, and overall family wellbeing.
9) Routine hearing screening and follow-up (especially if cleft palate is also present). Hearing checks are important because middle-ear fluid and hearing loss are common with cleft palate. The purpose is to protect hearing and language development. The mechanism is early detection of hearing changes so treatment is not delayed.
10) Watchful waiting vs ear tubes (case-by-case). Some children benefit from ventilation tubes (grommets), while others can be monitored carefully. The purpose is good hearing with fewer tube complications. The mechanism is choosing the right option based on persistent fluid, hearing level, and child development rather than “automatic tubes for all.”
11) Early speech and language checks (especially with cleft palate). Many children may need speech therapy at some point. The purpose is clear speech and confident communication. The mechanism is targeted practice that trains correct sound placement and reduces “cleft-type” speech errors over time.
12) Needs-based speech therapy (not fixed sessions). Therapy should match the child’s needs, not an arbitrary number of visits. The purpose is better outcomes for speech and language. The mechanism is regular reassessment and focused therapy goals (sounds, resonance, and language) as the child grows.
13) Dental and orthodontic planning over time. Teeth and jaw growth can be affected, especially when the gum (alveolus) is involved. The purpose is healthy teeth alignment and bite. The mechanism is staged care: early dental prevention, later braces, and coordinated timing with any bone graft needs.
14) Oral hygiene coaching (gentle, daily). Good mouth cleaning reduces infection risk and keeps gums healthier before and after procedures. The purpose is fewer mouth infections and better healing. The mechanism is reducing plaque and inflammation so tissues heal more cleanly after surgery.
15) Scar care education after repair. Families are often taught basic scar care after the wound closes (as advised by the surgeon). The purpose is a softer, flatter scar over time. The mechanism is good wound protection and consistent care that supports normal skin remodeling.
16) Protecting the lip repair (post-op handling rules). Caregivers learn safe holding and feeding so the stitches are not pulled. The purpose is to prevent wound opening. The mechanism is reducing tension and trauma while the repaired lip tissue bonds strongly during early healing.
17) Safe sleep and general infant care guidance. Good routine care (safe sleep, infection prevention, normal growth checks) matters because surgery requires a healthy baby. The purpose is readiness for anesthesia and surgery. The mechanism is fewer infections and better weight gain, which lowers peri-operative risk.
18) Regular growth monitoring (weight/length). Clinics track growth closely because feeding can be harder in some babies. The purpose is early action if weight gain is slow. The mechanism is simple: early nutrition support prevents malnutrition and helps the child reach surgery milestones safely.
19) Genetic counseling (when recommended). Some clefts are part of a syndrome or run in families. The purpose is to understand recurrence risk and any related health checks. The mechanism is reviewing family history and (if needed) genetic testing to guide future pregnancy planning and child screening.
20) Prevention counseling before pregnancy (public health care). Even when causes are unclear, reducing known risks helps future pregnancies. The purpose is lowering risk where possible. The mechanism is stopping smoking, controlling diabetes, reviewing epilepsy medicines with a clinician, and using folic acid before early pregnancy.
Drug treatments
Important: Cleft lip itself is not “cured by medicine.” These medicines are usually used for pain control, infection treatment/prevention, anesthesia support, nausea control, reflux, skin infection, or ear infections during the cleft-care journey. A clinician must choose the right drug and dose based on age/weight and the exact situation.
1) Acetaminophen (paracetamol). Used for mild to moderate pain and fever, often after surgery. Purpose: comfort so the child feeds and sleeps better. Mechanism: lowers pain signaling in the body and reduces fever. Dosage/time: depends on age/weight; often given in scheduled doses for a short period after procedures. Side effects: liver injury if overdosed.
2) Ibuprofen. Used for pain and inflammation (in some patients) after procedures. Purpose: reduce swelling and pain. Mechanism: reduces prostaglandins that drive pain and inflammation. Dosage/time: weight-based; usually short-term. Side effects: stomach irritation, bleeding risk, kidney stress in dehydration.
3) Ketorolac. A stronger NSAID sometimes used short-term for post-op pain. Purpose: reduce pain and opioid need. Mechanism: NSAID prostaglandin blocking. Dosage/time: short duration only, as directed in labeling. Side effects: bleeding risk, kidney risk, stomach irritation.
4) Morphine (opioid). Used for severe pain (usually in hospital). Purpose: strong pain relief so breathing and feeding recover smoothly. Mechanism: opioid receptor activation reduces pain perception. Dosage/time: clinician-controlled, closely monitored. Side effects: sleepiness, constipation, dangerous breathing slowing.
5) Oxycodone (opioid). Sometimes used for moderate to severe pain when other options are not enough. Purpose: pain control at home in select cases. Mechanism: opioid receptor activation. Dosage/time: individualized; shortest time possible. Side effects: constipation, nausea, dependence, breathing suppression risk.
6) Hydrocodone + acetaminophen. Another opioid combination sometimes used for stronger pain. Purpose: pain relief with a dual approach. Mechanism: opioid effect plus acetaminophen effect. Dosage/time: clinician-directed; avoid “double acetaminophen” from multiple products. Side effects: opioid risks plus liver risk if acetaminophen total is too high.
7) Fentanyl (opioid anesthetic pain medicine). Often used by anesthesia teams during surgery. Purpose: strong, fast pain control in the operating room. Mechanism: potent opioid receptor agonist. Dosage/time: given by trained anesthesia staff with monitoring. Side effects: breathing suppression, chest rigidity (rare), sedation.
8) Tramadol. An analgesic sometimes used in select patients (not appropriate for many children). Purpose: pain relief when other options are unsuitable. Mechanism: weak opioid activity plus neurotransmitter reuptake effects. Dosage/time: individualized; many pediatric restrictions exist. Side effects: nausea, dizziness, seizure risk, serotonin syndrome risk.
9) Naloxone. Emergency medicine used to reverse dangerous opioid breathing suppression. Purpose: safety when opioids cause overdose-like effects. Mechanism: blocks opioid receptors. Dosage/time: emergency use; may need repeat doses depending on opioid strength/duration. Side effects: sudden withdrawal symptoms in opioid-exposed patients.
10) Ondansetron. Used to prevent/treat nausea and vomiting after anesthesia or opioids. Purpose: keep the child comfortable and prevent dehydration. Mechanism: blocks serotonin (5-HT3) signals that trigger vomiting. Dosage/time: clinician-directed; often peri-operative. Side effects: headache, constipation; rare rhythm issues in high-risk patients.
11) Cefazolin. A common surgical antibiotic used around many operations to lower infection risk. Purpose: prevent surgical site infection when indicated. Mechanism: cephalosporin antibiotic that kills susceptible bacteria. Dosage/time: usually given in hospital near surgery time. Side effects: allergy reactions, diarrhea.
12) Amoxicillin-clavulanate. Used for certain ear, sinus, or respiratory infections (and other bacterial infections) when a clinician decides it’s needed. Purpose: treat mixed or resistant bacteria. Mechanism: amoxicillin kills bacteria; clavulanate blocks some beta-lactamases. Dosage/time: oral, for a prescribed course. Side effects: diarrhea, rash, allergy.
13) Amoxicillin. Used for many common bacterial infections based on diagnosis. Purpose: treat susceptible bacteria. Mechanism: penicillin-class antibiotic interfering with bacterial cell wall building. Dosage/time: clinician sets course length. Side effects: rash, diarrhea, allergy (rare severe).
14) Clindamycin. Option when penicillin allergy exists or for certain infections. Purpose: treat susceptible bacteria including some skin/soft tissue infections. Mechanism: blocks bacterial protein production. Dosage/time: oral or IV depending on severity. Side effects: diarrhea; risk of serious colon infection (C. difficile).
15) Cephalexin. Often used for skin/soft tissue infections when appropriate. Purpose: treat susceptible bacteria. Mechanism: cephalosporin antibiotic affecting bacterial cell wall. Dosage/time: oral course set by clinician. Side effects: stomach upset, rash, allergy in susceptible people.
16) Ofloxacin otic (ear drops). Used for certain outer or middle ear infections (sometimes after ear tubes). Purpose: treat ear infection locally. Mechanism: fluoroquinolone antibiotic that stops bacterial DNA processes. Dosage/time: drops for a set number of days as prescribed. Side effects: local irritation; allergy is rare.
17) Ciprofloxacin + dexamethasone otic (CIPRODEX). Used for some ear infections, including in children with ear tubes when indicated. Purpose: antibiotic plus inflammation control. Mechanism: ciprofloxacin kills bacteria; dexamethasone reduces swelling and irritation. Dosage/time: prescribed drops course. Side effects: discomfort in ear, rare allergy.
18) Mupirocin (topical antibiotic). Used for skin infections like impetigo if they occur, including around the nose/lip area (not directly on fresh surgical wounds unless surgeon says so). Purpose: clear superficial bacterial skin infection. Mechanism: blocks bacterial protein-making enzyme. Dosage/time: thin topical use as prescribed. Side effects: local burning/itch.
19) Lidocaine (with or without epinephrine). Local anesthetic used by clinicians for numbing and bleeding control during procedures. Purpose: reduce pain and reduce bleeding (with epinephrine). Mechanism: blocks nerve signal conduction; epinephrine narrows blood vessels. Dosage/time: clinician-administered only. Side effects: toxicity if overdosed, rare allergy.
20) Bupivacaine. A longer-acting local anesthetic used for regional blocks or infiltration in surgery. Purpose: longer pain control after the operation. Mechanism: blocks nerve signal conduction for hours. Dosage/time: clinician-administered only, carefully calculated. Side effects: heart/brain toxicity if it enters blood in high amounts.
(Common add-ons in some patients: dexamethasone for swelling/nausea and famotidine/omeprazole for reflux; these are included below as supportive options in many hospitals.)
Dietary molecular supplements (supportive; only if a clinician approves)
1) Folic acid (before and early pregnancy). This is the most important supplement for prevention planning (for future pregnancies), not for “treating” a baby already born with cleft lip. Purpose: support early embryo development. Mechanism: folate helps DNA building and cell growth in early pregnancy. Typical dose: 400 micrograms daily from trying to conceive until 12 weeks gestation (general guidance).
2) Iron (only if iron is low). Purpose: treat iron-deficiency anemia so oxygen delivery and growth improve. Mechanism: iron helps make hemoglobin. Dose: depends on lab tests and age; too much can be harmful. Side effects: constipation, stomach upset, dark stools.
3) Vitamin D (only if low or at risk). Purpose: bone and immune support. Mechanism: helps calcium absorption and bone mineral balance. Dose: depends on age and blood level. Side effects: excess can raise calcium and harm kidneys.
4) Zinc (short-term if diet is poor or deficiency suspected). Purpose: support wound healing and growth. Mechanism: zinc is used in many enzymes that repair tissue. Dose: clinician-guided (too much can cause nausea and reduce copper).
5) Omega-3 (DHA/EPA or DHA). Purpose: general nutrition support; sometimes used for overall growth and brain development. Mechanism: fatty acids support cell membranes and anti-inflammatory signaling. Dose: age-based, food-first when possible. Side effects: fishy burps; high doses may increase bleeding risk.
6) Vitamin B12 (if deficient). Purpose: healthy nerves and blood cells. Mechanism: supports DNA synthesis and red blood cell formation. Dose: depends on labs and cause of deficiency. Side effects: generally safe; rare acne-like rash.
7) Vitamin C. Purpose: collagen support for healing and immunity. Mechanism: helps collagen cross-linking and antioxidant defense. Dose: usually met through fruits/foods; supplement only if intake is poor. Side effects: stomach upset at high doses.
8) Probiotics (strain-specific; optional). Purpose: reduce antibiotic-associated diarrhea in some people. Mechanism: supports healthy gut bacteria balance. Dose: varies by product/strain. Side effects: gas; avoid in severely immunocompromised patients unless clinician approves.
9) Protein supplement (only if diet is inadequate). Purpose: support growth and wound healing. Mechanism: amino acids are building blocks for tissue repair. Dose: individualized by a dietitian, especially in children. Side effects: stomach upset if too concentrated.
10) Arginine/glutamine blends (special situations only). Purpose: sometimes used in nutrition plans to support healing in high-need patients. Mechanism: provides amino acids used in immune and tissue repair pathways. Dose: clinician/dietitian guided. Side effects: stomach upset; not needed for most children.
Medicines (immunity booster / regenerative / stem-cell related):
Important truth: There are no FDA-approved “stem cell drugs” that fix cleft lip, and clinics selling stem cell cures for cleft conditions outside proper trials should be treated with extreme caution. Most “immune booster” claims are marketing, not medical proof.
1) Becaplermin (topical growth factor for certain ulcers). This is not a cleft medicine, but it is an FDA-regulated growth factor used for specific chronic wounds. Purpose: help hard-to-heal wounds in selected cases. Mechanism: platelet-derived growth factor supports tissue repair signaling. Dose: applied as directed only for approved indications. Risks: cancer warning and local irritation.
2) rhBMP-2 (bone morphogenetic protein; used in some bone repair contexts). In craniofacial care, some centers study biologic bone-growth approaches, but use must be specialist-directed and indication-specific. Purpose: support bone formation where appropriate. Mechanism: signals cells to form bone. Dose: specialist-controlled. Risks: swelling and other complications depending on site.
3) Vitamin D prescription therapy (when medically low). Not a “booster,” but correcting deficiency supports immune function and bone health. Purpose: correct deficiency. Mechanism: hormone-like effect on calcium balance and immune regulation. Dose: depends on labs and age. Risks: high calcium if overused.
4) Zinc therapy (short course when deficient). Purpose: correct deficiency that can impair healing. Mechanism: supports enzymes involved in tissue repair and immune cell function. Dose: clinician-guided. Risks: nausea and copper deficiency if excessive.
5) IV/IM dexamethasone (peri-operative supportive use). Sometimes used by anesthesia teams to reduce swelling and nausea in surgery settings. Purpose: reduce inflammation and post-op nausea risk. Mechanism: steroid anti-inflammatory effects. Dose/time: clinician-administered around surgery when appropriate. Risks: blood sugar rise, immune suppression with repeated use.
6) Safe vaccination (prevention, not a drug “booster”). Vaccines do not treat cleft lip, but they reduce infection risk during infancy and childhood, which supports safer growth and surgeries. Mechanism: trains the immune system to recognize germs. Timing: per national schedule.
Surgeries (procedures and why they are done)
1) Primary cleft lip repair (cheiloplasty). Done to close the lip gap and improve function and appearance. Why: helps feeding, lip seal, and later speech development (and reduces social stress). How it helps: the surgeon brings muscle and skin layers together to rebuild normal lip shape.
2) Cleft nose repair / primary rhinoplasty (often combined with lip repair). Done to improve nose shape and breathing pathway symmetry when needed. Why: the cleft can pull nose cartilage out of position. How it helps: reshaping cartilage early can improve symmetry, though growth changes may still require later work.
3) Cleft palate repair (palatoplasty) (if cleft palate is present). Done to close the roof of the mouth so the child can make normal speech sounds and reduce nasal food leakage. Why: an open palate often causes speech problems and ear issues. How it helps: closes the opening and rebuilds muscle function for better speech.
4) Alveolar bone graft (gum-line cleft) (later childhood in selected cases). Done when the gum ridge has a cleft that affects teeth eruption and stability. Why: supports permanent teeth and braces planning. How it helps: adds bone so teeth and the dental arch become more stable for orthodontics.
5) Revision surgery (scar/lip/nose touch-up) (only if needed). Done if growth reveals tight scar, asymmetry, or functional issues. Why: some children need refinement for speech, breathing, or appearance. How it helps: adjusts tissue shape after growth, aiming for better function and confidence.
Preventions
1) Take folic acid before conception and in early pregnancy. This supports early development and is widely recommended for women trying to conceive.
2) Stop smoking before pregnancy. Smoking is a recognized risk factor for orofacial clefts.
3) Control diabetes before pregnancy. Pre-pregnancy diabetes is linked with higher risk, so good control matters.
4) Review epilepsy medicines with a clinician before pregnancy. Some epilepsy medicines are associated with increased cleft risk; never stop suddenly—plan safely with a doctor.
5) Avoid binge alcohol and avoid alcohol in pregnancy. Alcohol exposure is listed among non-genetic risk factors in surveillance guidance.
6) Aim for a healthy pre-pregnancy weight. Obesity is listed among risk factors in public health guidance.
7) Treat high fever quickly and seek care (especially early pregnancy). Maternal fever is listed among risk factors in surveillance guidance.
8) Get preconception counseling if cleft runs in the family. Genetic and environmental factors can both play roles, so counseling can help planning.
9) Follow safe medicine use in pregnancy. Only use medicines your clinician approves in early pregnancy, because some exposures can raise risk.
10) Early prenatal care and recommended supplements. Early care helps manage diabetes, nutrition, and medicine choices during the critical early weeks.
When to see doctors
See a doctor (or cleft team) immediately after birth if the baby has feeding difficulty, choking, poor weight gain, or breathing trouble. Also seek care if there are repeated ear infections, hearing concerns, delayed speech, or nasal regurgitation (milk coming through the nose), because these may signal cleft palate or related problems. Regular planned follow-ups matter even when the baby looks “fine,” because hearing, speech, teeth, and growth issues can appear later.
What to eat and what to avoid
1) Breast milk if possible, with positioning help. It supports growth and immunity, and many cleft-lip-only babies feed well with guidance.
2) If bottle feeding, use the teat/bottle your cleft team recommends. This improves safe milk flow and reduces exhaustion.
3) Feed slowly and burp more often. This lowers swallowed air and vomiting.
4) After surgery, follow the surgeon’s food texture plan. Many teams advise softer foods for a period to protect stitches.
5) Choose high-nutrition foods for older children. Protein, fruits, vegetables, and whole foods support healing and growth.
6) Avoid very hard, sharp foods soon after repair (if advised). These can injure the healing lip/palate repair.
7) Avoid bottle/nipple habits that pull on the repair (post-op). Use the feeding method your surgeon clears.
8) Avoid smoke exposure. Smoke irritates airways and increases infection risk.
9) Avoid unnecessary supplements. Use supplements only when there is a clear reason (like deficiency) and a clinician approves.
10) Keep hydration steady. Dehydration worsens constipation and can stress kidneys, especially if pain medicines are used.
FAQs
1) Is “harelip” the same as cleft lip? Yes—harelip is an older term; today the medical term is cleft lip.
2) Did the parents do something wrong? In most cases, no. Causes are often unknown and may involve genes plus pregnancy factors.
3) Can cleft lip happen alone? Yes. It can also occur with cleft palate.
4) Can a baby with cleft lip breastfeed? Many can, especially with positioning help; some need special bottles.
5) Why is weight gain so important before surgery? Good growth helps the baby tolerate anesthesia and heal well.
6) What is NAM? A presurgical molding method used in some infants to reduce the gap and improve nose shape before repair.
7) When is lip repair usually done? Timing depends on the program and baby’s health; many systems describe lip repair in early infancy.
8) Will my child need speech therapy? If cleft palate is present, speech issues are common and many children need therapy at some point.
9) Are ear infections related? They can be, especially with cleft palate, due to middle ear fluid and tube dysfunction.
10) Do all children need ear tubes? Not always; some need tubes, others can be monitored based on hearing and persistent fluid.
11) Are there “medicines that cure cleft lip”? No. Surgery repairs the cleft; medicines support pain control and infection care when needed.
12) Is cleft lip preventable? Not fully, but risk can be reduced with folic acid, no smoking, diabetes control, and safe medicine planning.
13) Will my child look “normal” after repair? Many children do very well, but scars and growth changes vary; some may need revision later.
14) Is cleft care only one surgery? Often it is a long plan (lip, possibly palate, dental/orthodontics, speech, hearing).
15) What is the best next step right now? Get care through a cleft/craniofacial team so feeding, surgery timing, hearing, and speech plans are coordinated.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 30, 2025.
Congenital Fissure of Lip
