Growth of Children with Cleft-Lip Palate from Birth to 10 Years of Age



Investigators have studied the growth of children with cleft lip and palate (CLP). However, there continues to be controversy whether children with isolated clefts attain normal growth or do in fact show different growth patterns as compared to typical children. Children with cleft-lip palate have difficulty to be breast and bottle fed due to the lack of intra-oral negative pressure, which is necessary for efficient sucking. They often present chocking, nasal obstruction, non-coordination of sucking with respiration and swallowing, prolonged feeding time, and their parents feel insecure to feed them. The reduced volume of ingested milk may lead to failure to thrive. The link between the oral and the nasal cavity in children with cleft palate may cause frequent airway infections and middle ear disease. The feeding difficulty and the higher frequency of infections are environmental factor that impairs physical growth of children with cleft palate in the first year of age. According to many studies, children with cleft palate, associated or not with cleft lip, show impairment in their length and weight growth in relation to children with isolated cleft lip. They are also smaller and lighter than the control subjects, mainly during the first year of age but a catch-up growth may occur later in childhood. A large 10-year longitudinal and prospective study showed that children with unilateral cleft-lip palate did not present any growth impairment from 2 to 10 years of age as compared with normal children. The growth curves established in this study can be used along with reference curves to monitor the growth of children with UCLP from 2 to 10 years of age.


Cleft Palate Physical Growth Feeding Difficulty Efficient Sucking Palate Malformation 



Centers for Disease Control and Prevention


Cleft-lip palate


Cleft lip and cleft palate


Growth hormone


Hospital de Reabilitação de Anomalias Craniofaciais – Universidade de São Paulo


Isolated cleft palate


Isolated cleft lip


Low social economic status


Median social economic status


Unilateral cleft lip and palate



I wish to acknowledge Arshad R. Muzaffar, Editor of The Cleft Palate Craniofacial Journal, Valerie Pierce, Publishing Coordinator of Allen Press Publishing Services, who granted permission rights for the original publication, Ana A. Gomes Grigolli, Librarian at Hospital de Reabilitação de Anomalias Craniofaciais – Universidade de São Paulo (HRAC-USP), Ricardo Pimentel Nogueira, Documentation and Information Technician at HRAC-USP, Lucas Ribeiro de Aguiar, Designer Assistant, and Elaine de Oliveira Martins, English teacher for their support and cooperation on the accomplishment of this chapter.


  1. Barakati SF, Alkofide EA. Growth status of Saudi patients with cleft lip and palate. Saudi Med J. 2002;23:823–7.PubMedGoogle Scholar
  2. Becker M, Svensson H, Källén B. Birth weight, body length, and cranial circumference in newborns with cleft lip or palate. Cleft Palate Craniofac J. 1998;35:255–61.PubMedCrossRefGoogle Scholar
  3. Bowers EJ, Mayro RF, Whitaker LA, Pasquariello PS, LaRossa D, Randall P. General body growth in children with clefts of the lip, palate and craniofacial structure. Scand J Plast Reconstr Surg Hand Surg. 1987;21:7–14.PubMedCrossRefGoogle Scholar
  4. Coy K, Speltz ML, Jones K, Hill S, Omnell ML. Do psychosocial variables predict the physical growth of infants with orofacial clefts? J Dev Behav Pediatr. 2000;21:198–206.PubMedGoogle Scholar
  5. Cunningham AS. Morbidy in breast-fed and artificially fed infants. J Pediatr. 1977;90:726–9.PubMedCrossRefGoogle Scholar
  6. Cunningham ML, Jerome JT. Linear growth characteristics of children with cleft lip and palate. J Pediatr. 1997;131:707–11.PubMedCrossRefGoogle Scholar
  7. Day DW. Accurate diagnosis and assessment of growth in patients with orofacial clefting. Birth Defects Orig Artic Ser. 1985;21:1–14.PubMedGoogle Scholar
  8. Drillien CM, Ingran TTS, Wilkinson EM. The causes and natural history of cleft lip and palate. Baltimore, MD: Williams Wilkins; 1966.Google Scholar
  9. Duncan PA, Shapiro LR, Soley RL, Turet SE. Linear growth: patterns in patients with cleft lip or palate or both. Am J Dis Child. 1983;137:159–63.PubMedGoogle Scholar
  10. Felix-Schollaart B, Hoeksma JB, Prahl-Andersen B. Growth comparision between children with cleft lip and/or palate and controls. Cleft Palate Craniofac J. 1992;29:475–80.PubMedCrossRefGoogle Scholar
  11. Gopinath VK, Muda WA. Assesment of growth and feeding practices in children with cleft lip and palate. Southest Asian J Trop Med Public Health. 2005;36:254–8.Google Scholar
  12. Jensen BL, Dahl E, Kreiborg S. Longitudinal study of body height, radius length and skeletal maturity in Danish boys with cleft lip and palate. Scand J Dent Res. 1983;91:473–81.PubMedGoogle Scholar
  13. Jones WB. Weight gain and feeding in the neonate with cleft: a three-center study. Cleft Palate J. 1988;25:379–84.PubMedGoogle Scholar
  14. Köster K, Butenandt O, Coerdt I. Growth and growth hormone in children with congenital lip and palatal clefts. Klin Paediatr. 1984;196:304–6.CrossRefGoogle Scholar
  15. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. 2000 CDC Growth Charts for the United States: methods and development. Adv Data. 2000;1–27.Google Scholar
  16. Laron Z, Taube E, Kaplan I. Pituitary growth hormone insufficiency associated with cleft lip and palate. An embryonal developmental defect. Helv Paediatr Acta. 1969;24:576–81.PubMedGoogle Scholar
  17. Lee J, Nunn J, Wright C. Height and weight achievement in cleft lip and palate. Arch Dis Child. 1996;75:327–9.PubMedCrossRefGoogle Scholar
  18. Lipman TH, Rezvani I, Mitra A, Mastropieri CJ. Assessment of stature in children with orofacial clefting. MCN Am J Matern Child Nurs. 1999;24:252–6.PubMedCrossRefGoogle Scholar
  19. Longui CA. A determinação da idade óssea na avaliação do crescimento. Temas Pediatr. 1996;61:1–26.Google Scholar
  20. MacRae DL. Management of the cleft palate child. J Otolaryngol. 1987;16:216–20.PubMedGoogle Scholar
  21. Marques IL, Borgo HC, Martinelli APMC, Nackashi J, Souza L, Dutka J, Pegoraro-Krook MI, Williams W. Longitudinal growth of children with unilateral cleft- lip palate from 2 to 10 years of age. In: 11th International congress on cleft lip and palate and related craniofacial anomalies, September 10–13; Fortaleza, Brasil. Fortaleza: SOBRAPAR; 2009a. p. 181.Google Scholar
  22. Marques IL, Nackashi JA, Borgo HC, Martinelli AP, Dutka J, Pegoraro-Krook MI, Williams WN, Dutka JC, Seagle MB, Souza TV, Garla LA, Machado Neto JS, Silva ML, Graciano MI, Moorhead J, Piazentin-Penna SH, Feniman MR, Zimmermann MC, Bento-Gonçalves CG, Pimentel MC, Boggs S, Jorge JC, Antonelli PJ, Shuster J. Longitudinal study of growth of children with unilateral cleft-lip palate from birth to two years of age. Cleft Palate Craniofac J. 2009b;46:603–9.PubMedCrossRefGoogle Scholar
  23. Montagnoli LC. Crescimento de crianças portadoras de fissuras lábio-palatais, de 0 a 2 anos [dissertação]. Ribeirão Preto: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo; 1992.Google Scholar
  24. Montagnoli LC, Barbieri MA, Bettiol H, Marques IL, de Souza L. Growth impairment of children with different types of lip and palate clefts in the first 2 years of life: a cross sectional study. J Pediatr (Rio J.). 2005;81:461–5.Google Scholar
  25. Nackashi JA, Rosenbloon AL, Marks R, Williams WN, Seagle MB, Frolova LE. Stature of Russian children with isolated cleft lip and palate. Cleft Palate Craniofac J. 1998;35:500–2.PubMedCrossRefGoogle Scholar
  26. Paradise JL, McWilliams BJ. Simplified feeder for infants with cleft palate. Pediatrics. 1974;53:566–8.PubMedGoogle Scholar
  27. Ross RB, Johnston MC. Cleft Lip and Palate. Baltimore, MD: Williams and Wilkins; 1972.Google Scholar
  28. Rudman D, Davis T, Priest JH, Patterson JH, Kutner MH, Heymsfield SB, Bethel RA. Prevalence of growth hormone deficiency in children with cleft lip or palate. J Pediatr. 1978;93:378–82.PubMedCrossRefGoogle Scholar
  29. Spina V, Rocha DL. Fissuras lábio-palatinas. In: Sucena RC. Cirurgia plástica: contribuição para o ensino da especialidade. São Paulo: Fundo Editorial da Sociedade Brasileira de Cirurgia Plástica; 1982. pp. 925–44.Google Scholar
  30. Tarsen SA, Homer DR. Relation of breast versus bottler feeding to hospitalization for gastroenteritis in a middle-class U.S. population. J Pediatr. 1978;92:417–8.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Hospital DepartmentBauru, SPBrazil

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