Is Cleft Lip and Palate Ever Isolated?:  Phenotype Is in the Eye of the Beholder

The parents of an infant with cleft lip and palate (CLP) often fear that their child may not be healthy in other ways. Although often unspoken, most families worry about the cognitive development of their child. There appears to be an innate human tendency to associate craniofacial malformations with abnormal cognitive development. Primary care providers and craniofacial teams examine and evaluate these children looking for signs of an underlying syndrome that might herald problems for the future. Finding nothing more than an “isolated” CLP, we as pediatric health care professionals are confident we can reassure families that the condition is treatable and that their child should be healthy in every other way. Those of us on large craniofacial teams have the opportunity to care for hundreds of children with CLP and have noted that the frequency of learning disabilities in this population appears to be higher than in the general pediatric population. Clinical research on the topic appears to substantiate this concern. That said, the assessment of developmental delay is complex in a child with facial differences that can have both functional and psychosocial impacts. The superimposition of abnormal palatal function, which leads to altered speech quality, and chronic middle ear effusions with or without recurrent episodes of otitis media can have significant impacts on speech and language development. It may be that we have too often attributed the developmental disability associated with clefting on the direct sequelae of the cleft and its psychosocial impact.