Critical Element of Care

1 THROUGH 4 MONTHS:

 Monitor feeding and growth 

• Repair cleft lip 

• Begin/continue pre-surgical orthopedics if indicated

5 THROUGH 15 MONTHS:

• Monitor feeding, growth and development 

• Consider ear tubes/assess hearing 

• Repair cleft palate

16 THROUGH 24 MONTHS:

• Monitor ear tubes and hearing 

• Assess speech-language and development 

• Monitor development 

2 THROUGH 5 YEARS:

Assess speech for VPI; consider interventions 

• Monitor ear tubes and hearing 

• Revise lip/nose before school if needed 

• Assess child’s development, including language and psychological adjustment 

6 THROUGH 11 YEARS:

• Assess speech for VPI; consider interventions 

• Orthodontic interventions and alveolar bone grafting 

• Monitor school performance and psychological adjustment 

• Involve child in medical decision-making process 

12 THROUGH 21 YEARS:

• Jaw surgery, rhinoplasty if needed 

• Final orthodontics 

• Genetic counseling 

• Assess overall psychological adjustment 

• Review school issues/vocational plans

References:

American Association of Oral and Maxillofacial 

Surgeons. (1995). Standards of Care for Cleft Lip 

and Palate. Berkowitz, S. (1994). The Cleft Palate 

Story. Chicago: Quintessence Publishing Co., Inc. 

American Cleft Palate-Craniofacial Association. (1993) Parameters for the evaluation and treatment 

of patients with cleft lip/palate or other craniofacial anomalies. Cleft Palate-Craniofacial Journal, 30, 

(Suppl. 1). 

American Cleft Palate-Craniofacial Association. (2010). Standards for Approval of Cleft Palate and 

Craniofacial Teams-Commission on Approval of Teams. www.acpa-cpf.org/Standards/Standards_

2010.pdf

American Cleft Palate-Craniofacial Association. (1996). Team Standards Self-Assessment Instrument. Berkowitz, S. (1994). The Cleft Palate Story. Chicago: Quintessence Publishing Co., Inc. 

Gorlin, R.G. (2001). Syndromes of the Head and Neck. [4th edition.] New York: Oxford University Press. Journal of Ultrasound Medicine, 10, 577. (1991) Losee, J & Kirschner, R. (2008). Comprehensive Cleft Care. McGraw-Hill Professional. 

Moller K.T. & Starr, C.D. (Eds.). (1993). Cleft Palate:Interdisciplinary Issues and Treatment. Austin, TX: Pro-ed. 

Office of Maternal and Child Health. U.S. Department of Health and Human Services. (1987). Surgeon General’s Report: Children with Special Health Care Needs. 

Shaw, William C., et al. (1992). A six-center international study of treatment outcome in patients with clefts of the lip and palate: parts 1-5. Cleft Palate-Craniofacial Journal, 29, 393-418. Sphrintzen, R.J. & Bardach, J. (1995). Cleft Palate Speech Management: A Multidisciplinary Approach. St. Louis, MO: Mosby. 

U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General.