refers to clefting of the lip (harelip)&/or the palate. The clefting can be part of a syndrome or isolated in nature. If syndromic the other defects making up the syndrome are investigated so that other problems can be addressed early on. The clefts are surgically repaired usually in the first year of life so that normal speech patterns can be developed by the early second year of life. Once speech patterns have developed it can be bery difficult to alter them. Despite surgical repair residual speech & swallowing problems may persist & may not completely respond to therapy.