The recognition and management of isolated cleft palate.

Cleft palate in the absence of a cleft lip (i.e. isolated cleft palate) causes upset for parents whenever it is diagnosed; however, delayed diagnosis at over 24 hours of age can cause increased distress due to feeding difficulties and fear of what else could have been missed. One third of cleft palates are not recognised within 24 hours of delivery. Considerable effort is being made to ensure early diagnosis following delivery, by raising awareness of midwives, neonatologists and paediatricians of the need to visualise the whole palate including the uvula, and through changes to the Newborn Screening Programme. Community practitioners including health visitors and school nurses are ideally placed to recognise key feeding and speech features associated with cleft palate, and then to refer to one of the nine regional cleft teams (England and Wales). There is a managed clinical network in Scotland, and there are also centres in Northern Ireland and Eire. Multidisciplinary cleft care commences in conjunction with local health services following referral to the regional specialist team.