Counsel a family on a newborn cleft lip and palate — OSCE

Communication tasks

Open by acknowledging the parents' worry and confirming what they have noticed, then explain the diagnosis in plain language: while their baby was developing, the upper lip and the roof of the mouth did not finish joining on the left side, which is called a cleft lip and palate. It is a common condition, it is not their fault, and it is very treatable. Reassure them that the gap will be closed by surgery and that the outlook is excellent. [1]

Address the feeding directly and practically. Acknowledge the mother's distress about breastfeeding — explain that the gap in the palate means the baby cannot create the suction needed to breastfeed or use a standard bottle, because the seal between the mouth and nose is broken, and that this is expected, not a reflection of her effort or the baby's ability. Reassure her that the squeeze bottle she is using now is exactly the right tool: it delivers milk by gentle compression rather than suction, and her expressed breast milk can go into it so the baby still benefits from her milk. Encourage her to hold the baby upright, pace the feed, and burp frequently. [7]

Outline the surgical pathway honestly and with clear timing. The lip will be repaired at around three months of age, when the baby is a bit bigger and stronger — surgeons often call this the rule of ten (about ten weeks old, ten pounds, and a good blood count), and the scar will fade over time. The palate is repaired a bit later, between nine and eighteen months, before the baby starts talking so that speech develops normally. When the baby is around nine to eleven years old, a small bone graft fills the gap in the gum so the permanent teeth come through properly. There may be some minor revision surgery in the teenage years to refine the nose and the bite. All of this is planned with the family over years, not weeks. [2]

Address the fear of deafness. Explain that the hearing screen referred because the gap in the palate affects the tiny muscles that open the tube between the ear and the throat, so fluid can build up in the middle ear — this is very common in cleft palate and is a conductive problem, meaning the inner ear and the hearing nerve are fine. When the palate is repaired, the team will also place small ventilation tubes (grommets) in the ear drums to drain the fluid and restore normal hearing for speech development, and the hearing will be checked regularly through childhood. [10]

Close with a clear plan and safety-net. Refer the family to the cleft team, who will coordinate the surgeons, the orthodontist, the speech pathologist, the audiologist and a paediatrician across the child's development. Give the family a written plan, a named contact, and the first appointment date. Bring the baby back sooner if there is any concern about feeding, weight gain, breathing (especially when asleep), or the good side of the mouth. Invite questions, confirm understanding, and set the first follow-up. [1]