Individuals with nonsyndromic SMCP present with speech difficulties similar to those experienced by individuals with overt cleft palate. Health care professionals should be aware of possible presenting symptoms and consider early SMCP diagnoses where appropriate. Further research is needed to specify the broader communication profile in this population.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Background W hen a cleft lip (CL) occurs, the lip is not contiguous, and when a cleft palate (CP) occurs, there is communication between the oral and nasal cavities (see Fig. 1 for a completely formed lip and palate). 1 CL may involve the lip only; lip and alveolus; or lip, alveolus, and a notch in the hard palate. The notch in the hard palate may extend all the way to the incisive foramen (Fig. 2). 2 Similarly, a CP may involve only the uvula (e.g., bifid uvula), the uvula and soft palate, or extend through both the hard and soft palates (Fig. 3). 1 In a complete cleft of hard and soft palates, there is no bone or muscle separating the oral and nasal cavities. A CP may be submucosal and not immediately detected intraorally if there are subtle or no corresponding clinical signs or symptoms. 1 Therefore, it is essential that health professionals check for palatal clefting (both overt and submucosal) on initial presentation, by visually inspecting and palpating the palate. This should be done using a tongue depressor and flashlight to allow for inspection of the entire palate, including the uvula. An oral examination is of relevance if an infant is presenting with feeding difficulties or not gaining weight. Surgical cleft repairs can involve multiple procedures, depending on the nature and extension of the cleft (i.e., unilateral CL versus bilateral cleft lip and palate [CLP]). The primary repair(s) are generally completed within 18 months of life, with the lip being repaired before the palate at 3-9 months of age. 3,4

This study is the first formally to examine language skills alongside non-verbal IQ in school-aged children with clefts compared with a large matched non-cleft population. Results suggest that health professionals should evaluate each child as they present and not assume that a child with non-syndromic CLP or CP will also have co-occurring language difficulties. Where language falls in the average range, these skills can be harnessed to support areas of difficulty often associated with orofacial clefting, such as speech.