A clinical mnemonic to promote best practice in neonatal palate examination.

The incidence of late diagnosis of isolated cleft palate continues to be reported, without improvement, in the United Kingdom (UK). The CRANE database progress report for 2012 identified late diagnosis for children with isolated cleft palate at 28% of all known cases (Fitzsimmons et al 2012), with this proportion increasing to 32%, reported by CRANE the following year (Fitzsimmons et al 2013).

These findings are measured against agreed national standards which state that all babies born with cleft lip and/or palate should be identified at birth or soon after (Bannister 2008). However, as the previous statistics demonstrate, clinicians are still failing to identify isolated cleft palate, whether of the soft palate alone or involving the hard palate. As Butcher (2007) suggested several years ago the inadequacy of digital palate examination alone can easily miss a soft palate cleft, highlighting the importance of visualisation to identify and classify clefts of both the soft and hard palate, as well as incidences of bifid uvula. Despite this knowledge, and from clinical experience, the authors would suggest that much of current practice for neonatal palate examination relies only on digital examination, an assertion which is supported by the continuing incidence of late diagnosis. To help illustrate this point the following case studies have been adapted from the author’s own experiences.