All the newborn babies are examined by a pediatrician in the hospital. When a child is born with a cleft lip and/or palate, the pediatrician usually asks a plastic surgeon to examine the baby. Two primary concerns that all doctors have are how well the baby is breathing and eating. Breathing and eating difficulties are most often experienced in infants born with a cleft palate and a very small lower jaw. Children with Pierre Robin syndrome have small jaws. The jaw holds the tongue out and hence with a small jaw the tongue falls back into the throat causing blockage of air passage. The treatment of the airway takes the priority in the management of the child with cleft. Obstructed airway can be managed with positioning but in severe cases may need a tracheostomy.

The timing of the initial cleft lip and palate repair varies from plastic surgeon to plastic surgeon. Our team surgeon repairs most cleft lip and palate within the infant's first few days of life. After the repair, a baby's appearance is dramatically improved and feeding problems are significantly minimized.

Sometimes it is not possible to repair a cleft palate at the same time as the lip because the palatal opening may be too wide. In such cases, the palate can be repaired 3 months after the lip to allow for sufficient growth of the palate.

Our plastic surgeon covers the deformity of the nose at the same time as the initial cleft lip repair. This allows the child's nose to grow into normal shape. In babys with a cleft of both sides of the lip (bilateral cleft), the nose is very short and flat. When these children have the initial lip repair, a small amount of tissue is saved (which shows as tiny nubbins in the nostril). This is used when the nose is lengthened, usually six months after the first lip repair.