Cleft lip/palate and child development

Cleft lip and palate is one of the most common congenital malformations affecting around one in 650 children. Despite the fact that in the developed world surgery is usually carried out for the condition at between three and four months people affected by it have been found to be at an increased risk of psychological difficulties including cognitive problems in infancy and early school, particularly with verbal IQ. Researchers have previously found an association with the quality of mother-child interaction at two months and cognitive development at 18 months; the theory being that shock, worries about forthcoming surgery, feeding problems and the difficulty of engaging with a disfigured child affect the relationship between a mother and her child, in turn affecting children's development. The same team of researchers, led by Francoise Hentges from the University of Reading, followed up a group of 170 children seven years later. 44 had early cleft-palate surgery, 49 late surgery and 77 were unaffected 'controls.' The study found that the children who had had cleft palate scored significantly lower on tests of cognitive development. This was mostly mediated  by 'maternal sensitivity' at two months, even after allowing for the later effects of mother-child interaction. The study shows both how parents of children with cleft lip/palate need support from day one and how crucial the first few months are in a child's development.

Hentges, Francoise ... [et al] - The effect of cleft lip on cognitive development in school-aged children: a paradigm for examining sensitive period effects Journal of Child Psychology and Psychiatry doi:10.1111/j.1469-7610.2011.02375.x

Cleft lips and later problems

Cleft lip and palate affects one in every 650 children. In the school years affected children are at raised risk for both socio-emotional and cognitive difficulties. An important question is the extent to which the problems of children with clefts may be explained by difficulties in parent-child interactions since these often predict poor child functioning. Giving birth to an infant with a cleft is often followed by shock and distress and this may affect parent-child interactions. A U.K. study of 190 very young children looked at the child's relationship with their mothers at two, six, twelve and eighteen months and measured their behaviour problems and mental development at eighteen months. Some of the children had clefts which were repaired early (before 3-4 months), others had clefts which were repaired later and others were unaffected by the condition. The study found that early interaction difficulties between mothers and the children who had 'late' repair for their cleft lips and palates were associated with poor cognitive functioning at 18 months.

Murray, Lynne ... [et al] - The effect of cleft lip and palate, and the timing of lip repair on mother-infant interactions and infant development Journal of Child Psychology and Psychiatry February 2008, 49(2), 115-123