Cleft Palate Symptoms: Early Signs & Warning Signs

Quick Glance: Common Cleft Palate Symptoms

Common symptoms and signs associated with cleft palate include:

A visible opening or split in the roof of the mouth
Difficulty sucking or feeding
Trouble creating a good seal around the nipple during feeding
Milk, formula or food coming out through the nose
A nasal-sounding voice or speech
Recurrent middle ear infections or persistent fluid buildup behind the eardrum
Hearing difficulties or hearing loss
Dental problems are particularly problematic when the cleft affects the gum or is associated with a cleft lip

The exact cleft palate symptoms depend on whether the cleft affects the hard palate, soft palate or both. A submucous cleft palate can be difficult to notice because the mouth looks normal on the surface. However, it can affect the underlying muscles and may later cause problems with feeding, speech, or the ears.

Cleft Palate Symptoms That Should Not Be Ignored

Symptoms of cleft palate that require urgent attention are as follows:

Symptom	What It May Indicate
Persistent difficulty feeding	The palate may not allow effective suction or separation between the mouth and nose.
Milk or food repeatedly coming through the nose	An opening between the oral and nasal cavities.
Frequent ear infections	Dysfunction of the Eustachian tube, which can occur with a cleft palate
Reduced response to sounds or suspected hearing difficulty	Middle-ear fluid or hearing impairment.
Nasal-sounding speech	Difficulty achieving normal separation between the mouth and nose during speech.
Difficulty swallowing	A less common symptom that may occur with some cleft palate presentations.
Dental abnormalities	A cleft involving the gum or associated oral structural differences.

Why Do Cleft Palate Symptoms Occur?

Cleft palate symptoms occur because the palate, or roof of the mouth, has not formed as a continuous structure during foetal development.

The palate normally separates the oral cavity from the nasal cavity. When an opening remains, this separation is incomplete, which can affect feeding, speech and other functions.

In babies, effective feeding requires coordinated sucking, swallowing and breathing. A cleft can make it difficult to create the pressure and seal needed for efficient sucking. As a result, a baby may take longer to feed, tire during feeds or have milk coming through the nose.

The Eustachian tubes, which help equalise pressure and drain fluid from the middle ear, may also function differently in children with cleft palate. This can increase the likelihood of fluid collecting behind the eardrum, recurrent ear infections and hearing difficulties. Hearing problems can, in turn, affect speech and language development if they are not identified and managed.

Dental symptoms may occur when the cleft extends into the gum or when a child has an associated cleft lip. Depending on the individual presentation, teeth may be missing, displaced or develop differently.

Cleft Palate Symptoms That Require Immediate Medical Attention

Seek immediate medical attention if a child shows any of the following emergency signs:

Significant difficulty breathing
Choking or repeated episodes of breathing difficulty during feeds
Signs of severe dehydration, such as very few wet nappies, extreme sleepiness or inability to keep fluids down
Persistent vomiting with inability to feed
Blue or grey colouring of the lips or skin
Loss of consciousness or marked unresponsiveness
Severe difficulty swallowing associated with breathing problems

Feeding difficulties in a newborn should be assessed promptly, particularly if the baby is unable to take enough milk or shows signs of dehydration or poor weight gain.

Symptoms of Cleft Palate Based on Type

The symptoms and their severity of cleft palate vary according to the location and extent of the cleft. Here are the symptoms of cleft palate based on its type:

Type of Cleft Palate	Symptoms
Hard palate cleft	Visible opening in the roof of the mouth, feeding difficulty, milk or food may pass towards the nose, possible speech difficulties.
Soft palate cleft	Feeding difficulties, nasal-sounding speech, recurrent ear infections, possible hearing problems.
Complete cleft palate	More extensive feeding difficulties, nasal regurgitation, speech problems, increased risk of middle-ear problems and hearing difficulties.
Submucous cleft palate	May be difficult to see, feeding difficulty, nasal speech, recurrent ear infections, swallowing problems in some cases.

Can You Have a Cleft Palate Without Symptoms?

A cleft palate is not always obvious. A typical cleft involving the roof of the mouth is generally visible at birth, but a submucous cleft palate can be hidden beneath the lining of the palate.

Some children with a submucous cleft may have few noticeable symptoms initially. The condition may only become suspected when a child develops persistent feeding difficulties, a nasal-sounding voice, recurrent ear infections or problems with swallowing.

When Can Cleft Palate Symptoms Become Life-Threatening?

The table below highlights cleft palate symptoms that may signal serious complications:

Symptoms	What can happen
Severe feeding difficulty	A newborn who cannot take enough milk may become dehydrated or fail to gain weight.
Breathing difficulty	Any significant breathing problem, particularly during feeding, requires immediate assessment.
Choking or aspiration	Repeated choking or suspected entry of feeds into the airway needs prompt medical evaluation.
Severe dehydration	Reduced urine output, unusual sleepiness or inability to feed can indicate significant dehydration.
Associated congenital conditions	In some children, cleft palate occurs as part of a genetic syndrome or alongside other birth differences that may require urgent assessment.

How are Cleft Palate Symptoms Diagnosed?

A doctor may identify a cleft palate during a newborn examination. If the cleft is subtle or submucous, the following assessments may be needed when symptoms develop:

Diagnostic Assessment	Purpose
Physical examination of the mouth and palate	Identifies an opening in the hard or soft palate and assesses its location and extent.
Examination for submucous cleft palate	Looks for subtle structural signs when the palate appears intact but symptoms suggest an underlying defect.
Prenatal ultrasound	May identify some cleft palate presentations before birth, although an isolated cleft palate can be difficult to detect.
Feeding assessment	Evaluates sucking, swallowing, feeding efficiency and possible nasal regurgitation.
Hearing assessment	Checks for hearing loss associated with middle-ear fluid or recurrent ear problems.
Speech and language assessment	Evaluates speech clarity, nasal speech and language development in older children.
Dental and oral assessment	Identifies tooth development or alignment problems, particularly when the gum is affected.
Further specialist assessment	May be recommended when a cleft is suspected to be part of a broader genetic or congenital condition.

FAQs

Q1. What is the first symptom of cleft palate?

Ans: A visible opening in the roof of the mouth may be the first sign of cleft palate and is often identified shortly after birth. However, a submucous cleft palate may not be immediately visible and can first present with feeding problems, nasal speech or recurrent ear infections.
Q2. What are the early warning signs of cleft palate?

Ans: Early warning signs of cleft palate may include difficulty sucking or feeding, prolonged feeding times, milk coming through the nose, poor feeding efficiency and difficulty gaining weight. In some cases, recurrent ear infections or nasal-sounding speech may be the first clues.
Q3. Can a cleft palate develop after birth?

Ans: No. A cleft palate is a congenital condition that develops before birth while the baby's palate is forming.
Q4. Can a child have a cleft palate without a cleft lip?

Ans: Yes. A cleft palate can occur on its own without affecting the lip. Some children have an isolated cleft palate, while others have both a cleft lip and a cleft palate.
Q5. Which cleft palate symptoms should never be ignored?

Ans: Persistent feeding difficulty, poor weight gain, repeated choking, significant breathing problems, severe dehydration, recurrent ear infections with suspected hearing loss and marked speech difficulties should be medically assessed in cleft palate cases.
Q6. Can cleft palate symptoms vary from child to child?

Ans: Yes. Symptoms of cleft palate depend on the location and size of the cleft, and on whether it affects the hard palate, soft palate, or both. Children with a submucous cleft may have subtle symptoms that appear later.
Q7. When should I see a doctor for a suspected cleft palate?

Ans: A baby with a visible cleft palate should be assessed by a healthcare professional so that feeding, hearing and other needs can be evaluated. If an older child has persistent nasal speech, unexplained feeding problems, recurrent ear infections or suspected hearing difficulties, a doctor should also be concerned.
Q8. Which cleft palate symptoms indicate an emergency?

Ans: Emergency cleft palate symptoms include severe breathing difficulty, repeated choking, blue or grey skin tone, signs of severe dehydration, loss of consciousness, or complete inability to feed.