Cleft lip and palate frequently occur together and are among the five most common congenital conditions in South Africa, though often underreported*. “Studies estimate the combined prevalence in the public health sector to be around 0.3 per 1,000 live births,” shares Dr Briner. “Boys are also more commonly affected than girls in cases of cleft lip or cleft lip with palate, with a 2:1 ratio, while females are slightly more at risk for isolated cleft palates,” adds Dr Larisse Badenhorst, a general practitioner and co-owner of Johannesburg’s Well Family Practice. The exact cause of these conditions is often unclear and not always preventable, but genetics and environmental factors likely play a part, shares Dr Briner. For instance, a family history can increase the risk, along with factors like smoking, substance use during pregnancy, certain medications, obesity, diabetes, poor nutrition, pollution, or advanced maternal age. Clefts are often spotted in prenatal ultrasounds or diagnosed at birth and early identification is crucial for providing a baby with tailored medical, nutritional, and emotional support. So, how do clefts affect children, and how can modern treatments help them thrive? CLEFT COMPLICATIONS Children with a cleft lip, with or without a cleft palate, may face various challenges depending on the condition’s severity, including: • Feeding difficulties – clefts may affect sucking, requiring specialised feeding tools. • Ear infections and hearing loss – disrupted ear-throat function can lead to frequent infections and hearing problems. • Dental issues – clefts affecting the upper gum may disrupt tooth development, alignment, and oral health. • Speech difficulties – muscle function issues can delay speech or cause abnormalities. • Emotional and social challenges – visible differences and medical demands may impact self-esteem and peer relationships . THE LOWDOWN ON SURGERY Surgical treatment for cleft lip and palate depends on a child’s specific needs and is most effective within the first five years of life, explains Dr Badenhorst. For instance, cleft lip repair is typically done at 3 to 6 months, closing the gap, restoring lip function, and often reshaping the nose for symmetry. Palate repair, on the other hand, is usually performed between 9 and 18 months to close the roof of the mouth CONTENTS | 43 BETTER CHILD