Submucous cleft palate in the differential diagnosis of feeding difficulties.

Submucous cleft palate is a missed or forgotten diagnosis. We reviewed 81 patients with submucous cleft palate seen over a 15 year period; 26 of these patients were interviewed. The patients were divided into three main groups according to the referral pattern. Children under 2.5 years were referred by a paediatrician for feeding problems; children aged 2.5-10 were referred mainly by speech therapists; and those over 10 had a varied pattern of referral. Thirty nine of the 81 had problems with feeding, but of the 26 interviewed, 22 had feeding problems. Not all patients with a submucous cleft palate are symptomatic and require active treatment, but children with this condition have the same high incidence of middle ear disease as those with overt cleft palate. We suggest that the diagnosis of submucous cleft palate be included in the differential diagnosis of feeding difficulties, with early referral to a specialist cleft palate team.