Most of us have seen pictures of children who have had plastic surgery to repair a harelip. A harelip is an old term for what is now called a cleft lip. Harelip refers to a split in the lip at birth that looks rather like the split in a hare's lip — hence the term. The term harelip originated in France ("lip like a hare's") and the English shortened it to harelip. The term harelip is considered somewhat pejorative now, and cleft lip is preferred.
A cleft lip occurs when a child's mouth does not form correctly in the womb. The cleft lip is almost always accompanied by a cleft palate, which means the child's hard palate did not fuse together correctly. A cleft lip can be unilateral or bilateral, but it and the cleft palate can be completely repaired.
The cleft lip/palate birth defect occurs in one in 700 live births. Occasionally, it is a genetic defect, but often it is spontaneous, and the child will have no family history of the defect. Sometimes it is detected on sonogram, but often it is not visible until birth.
The cleft lip/palate presents some special problems for newborns, especially in feeding. Most babies with a harelip cannot be breastfed, and must use a bottle with a special nipple for the unique shape of their mouths. The child will also have a team of experts to address his needs: a pediatrician, plastic surgeon, audiologist, speech therapist, pediatric dentist, orthodontist and ear, nose and throat specialist. These professionals work together to make sure the parent is informed of all treatment options, what progress to expect, and how to overcome obstacles.
Because the cleft often affects the sinuses and ears, a cleft lip/palate child will often be prone to ear infections and upper respiratory infections. Although the great majority of these children have normal intelligence, issues with their mouth and ear structure may necessitate the services of hearing and speech therapists.
The harelip is repaired at age 10 weeks if the baby weighs 10 pounds. The cleft palate is repaired between the ages of nine and 12 months, depending on the child. Other plastic surgery or palate surgery may be required as the child grows, but it is aimed at improving what has already been done. Resources on the Internet and support groups are available for parents of these special children. The good news is that the defect can be completely repaired, and most children go on to lead healthy, normal lives.
