Palate examination: Identification of cleft palate in the newborn - best practice guide

A cleft palate occurs when the roof of the mouth has not joined completely. A delay in its detection may adversely affect growth, development and timely medical and surgical management. This NICE accredited evidence-based best practice guide provides recommendations on optimal examination of the newborn palate during the routine examination to ensure early detection of a cleft palate.
Baby being examined for cleft palate

In 2015, in collaboration with key partners, we developed this guide to aid neonatologists, paediatricians, nurses, midwives, GPs, health care assistants and any other health care professional to detect cleft palate in neonates, as well as to improve and standardise routine postnatal examination of the palate.

This best practice guide is NICE accredited and has been developed in accordance with RCPCH Setting standards for development of clinical guidelines in paediatrics and child health.

It provides advice on appropriate methods for detecting cleft palate in babies (from birth to 28 days of age examined routinely as part of the newborn examination, usually within 72 hours of birth). While it aims to help healthcare professionals in their everyday work, it does not replace clinical knowledge and expertise.

Our parent and carer guide explains what health professionals look for when your baby has a palate examination.

Six key recommendations

  • Healthcare professionals should examine a baby’s hard and soft palate as part of the full newborn physical examination and record this in the child health record.
  • Examination of the baby’s palate should be carried out by visual inspection.
  • A torch and method of depressing the tongue should be used to visualise the whole palate.
  • Parents should be informed if the whole palate (including the full length of the soft palate) has not been visualised during the newborn examination.
  • If the whole palate is not able to be visually inspected at first attempt then a further attempt at visual examination should be made within 24 hours.
  • Trusts should provide training on the correct method of visual inspection of the palate to all healthcare professionals required to carry out the newborn examination.

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