Does your baby sometimes have milk coming out of his nose when he's breastfeeding? Or does he often get earaches? Does he find it hard to pronounce certain words? Although these are things we sometimes don't pay much attention to, sometimes this could be due to a condition called Submucous Cleft Palate (SMCP) . Don't worry, moms and dads, we'll talk about this simply, in a way that you can understand.
What is Submucous Cleft Palate (SMCP)?
Simply put, Submucous Cleft Palate (SMCP) is a cleft in the roof of the mouth. But it's not like a normal cleft palate. The word "submucous" means "under the mucous membrane." The roof of your mouth, called the palate , is made up of two parts. The hard palate in the front and the soft palate in the back. In SMCP, the muscles of the soft palate, which are located under the thin membrane on top of the roof, don't come together properly. This happens during fetal development while the baby is in the womb.
Think of it like something is being covered with a cloth, but something is not properly attached underneath the cloth. That's why it's not immediately visible from the outside. Not everyone shows symptoms of this. However, this condition can make your child more likely to have speech problems , frequent ear infections , and difficulty feeding as a baby.
How common is this condition?
Submucous Cleft Palate is a relatively rare condition . It affects a very small percentage of babies born. However, some babies do not show any obvious symptoms, so the actual number of babies with this condition may be slightly higher. This is because there is no obvious outward sign, so it can sometimes be detected too late.
How do I know if my child has this condition?
It's hidden under the membrane, so it's hard to see right away. But, see if you've noticed any of these things about your baby:
- Did you have any difficulties breastfeeding as a baby? (e.g., milk coming out of the nose, taking a long time to finish breastfeeding)
- Do you often experience earaches or ear infections?
- Do you feel like he has difficulty pronouncing certain words and letters?
If you notice anything like this, tell your child's pediatrician so he or she can examine your child's palate carefully.
What are the symptoms of a Submucous Cleft Palate?
There are several main symptoms that can be seen in a child with this condition.
Symptoms you may observe in your child:
- Lactation difficulties: Especially in infancy, whether bottle-feeding or breastfeeding, your baby may have difficulty sucking. It may take longer than a normal baby to finish feeding. Sometimes , milk or formula may come out of the nose . Imagine, when you breastfeed your baby, a little milk often comes out of the nose. This is not just once or twice, but if it happens regularly, you should be concerned.
- Frequent ear infections: These children may experience frequent ear infections, such as earaches and ear discharge.
- Speech difficulties: Some letters and words may be difficult to pronounce clearly.
- Nasal speech: When you speak, it may feel as if the words are coming from your nose , like someone with a bad cold.
- Air coming out of the nose when speaking: It may feel like air is coming out of the nose when the child speaks.
Symptoms that a doctor may see when examining a child's mouth include:
When a doctor examines the inside of a child's mouth, they may see things like:
- Bifid Uvula: The small tongue-like part (uvula) that hangs at the back of our throat may appear to be split in two.
- A blue/gray appearance in the middle of the soft palate (`(Zona Pellucida)`) : A blue or grayish color can be seen under the membrane in the middle of the soft palate.
- A 'V' shaped groove on the hard palate : You can see a small 'V' shaped groove on the back of the hard palate in the front of the upper palate.
The nasal snoring and the air coming out of the nose while speaking is caused by a condition called Velopharyngeal Dysfunction (VPD) . Simply put, this happens when the back of the soft palate does not close properly when speaking. Then, the sound and air that should come out of the mouth comes out through the nose. Not everyone with Submucous Cleft Palate has this condition, but this is the main problem that affects speaking.
What are the causes of Submucous Cleft Palate?
There may be several reasons for this. Mainly:
- Genetic factors: This condition can be caused by genetic influences inherited from parents.
- Environmental factors: This can also be caused by the mother's exposure to certain things while the baby is in the womb (e.g., certain medications, tobacco, alcohol, toxic chemicals).
How to diagnose a Submucous Cleft Palate?
Your child's pediatrician will first examine your child's mouth. If he or she suspects SMCP, they will refer your child to a speech therapist , an otolaryngologist or ENT specialist, or a surgeon who specializes in cleft palates. SMCP can be difficult to diagnose because it is not easily visible and may not cause any serious symptoms.
This team of specialist doctors comes together to determine the nature of the problem and what type of treatment is most appropriate.
To further confirm this situation, the following tests can be performed:
- Nasopharyngoscopy: This involves inserting a small camera-equipped tube through the nose and examining the back and sides of the throat . Some of the lesions can be seen clearly when viewed this way.
- Videofluoroscopy: This is like an X-ray test . It allows you to watch the movement of the palate as the child speaks and swallows something, as if on video.
How is a Submucous Cleft Palate Treated?
Treatment depends on the type of problems your child is having with the condition. Some children have difficulty speaking or ear infections, while others have no symptoms at all.
- If there are no symptoms: If the child is not experiencing any discomfort or has trouble speaking, treatment is usually not needed. However, doctors will continue to monitor the child.
- If you have speech problems (Velopharyngeal Dysfunction): If you have symptoms such as nasal snoring, such as the aforementioned nasal snoring, or air coming out of your nose while speaking, you may need to undergo surgery (`(Palatoplasty)`) . This surgery involves repairing the soft part of the palate and closing the opening. Then, when you speak, the palate closes properly, preventing air and sound from coming out of your nose.
- Speech Therapy: In many cases, a child will need speech therapy to learn how to pronounce certain sounds correctly. Sometimes surgery alone can correct the condition, and speech therapy is not necessary.
- For ear infections: If you have frequent ear infections, you can have small tubes inserted into your ears to prevent them, maintain good hearing, and help with speech development.
Important: Studies have shown that children with Submucous Cleft Palate should not have adenoidectomy , as this surgery may worsen speech problems or cause new velopharyngeal dysfunction .
Will my child need surgery?
Surgery is not necessarily necessary. If the child has no problems speaking, surgery is usually not recommended. Instead, doctors will monitor the child for several years to see if any problems develop.
Will my child need speech therapy?
Yes, in most cases, the child will need speech therapy . A speech therapist (`(Speech Pathologist)`) will examine your child and determine what speech difficulties are caused by this cleft palate. Some problems are caused by physical causes (i.e., changes in the structure of the palate). They can be corrected with surgery. But some pronunciation errors are things that the child has learned incorrectly. Speech therapy is essential to change those habits and teach them to pronounce correctly.
Can a Submucous Cleft Palate be prevented?
This cleft palate is a congenital condition . Therefore, it is difficult to completely prevent it. However, as mentioned earlier, environmental factors can also affect this, so as a mother, avoiding the use of certain medications, drugs, alcohol, and other toxic chemicals during pregnancy can reduce the risk of a child developing this condition to some extent.
What questions should you ask your child's doctor?
After your child is diagnosed with Submucous Cleft Palate , it's normal to have many questions to ask your doctor. Here are some questions you might want to ask:
- What is the reason for this?
- Will my child need surgery?
- Will my child need speech therapy?
- Has this condition affected my child's hearing?
- How long does the treatment take?
- Are there things I can do at home to help my child?
So, if your child has speech problems, frequent earaches, or had difficulty sucking or bottle-feeding as a baby, he or she may have a submucous cleft palate . It can be difficult to diagnose, but some children may have symptoms. Talk to your child's pediatrician and have your child's mouth and throat examined. In most cases, the condition can be completely corrected with speech therapy or surgery.
The most important things we need to learn from this (Take-Home Message)
- Submucous Cleft Palate is a cleft in the upper palate, hidden from view, beneath the thin membrane.
- If your baby has milk coming out of his nose when he drinks, if he has frequent earaches, if his speech is unclear, or if he makes a nasal sound , it is very important to have him checked by a doctor.
- This condition can be a little difficult to diagnose , but once correctly diagnosed, there are treatments.
- Not every child needs surgery. For some children, speech therapy alone may be enough.
- Don't worry. Proper medical advice and treatment can provide relief to your child. Talk to your doctor about this openly.
Remember, you are not alone. There are other parents facing similar situations. With the right awareness and medical support, you can give your child the best possible outcome.
` Cleft palate, submucous cleft palate, speech problems, breastfeeding difficulties, ear infections, palatoplasty, child health
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